Overheard in ER

Nurse 1: "I need another urine sample cup for room 17."

Nurse 2: "Didn't you just give him one?"

Nurse 1: "Yeah. I gave him the cup and a Betadine swab. I told him to wipe himself first, then put it in the cup. So he wiped his dick with the swab, then put the swab in the cup."

Halloween memories - epilogue

For those wondering after reading Friday's post...

This, in memory of my grandfather, is the tie I wore. He bought it as an honest-to-God ordinary tie that he wore to his job. It is truly one of my most prized possessions, because, let's face it, ties this hideous aren't easy to find.

Sure, you can buy lots of gag ties that are intentionally horrid, but what makes this thing so awesome is that someone designed it in the 60's-70's as a serious tie for men to wear to business meetings, Bar Mitzvahs, whatever. And my grandfather paid good money for it and DID JUST THAT.

The day I found it in his closet, I knew I'd stumbled on something rare and worth keeping. Someday I'm sure one of my descendants will do the same.

The picture doesn't do the bright colors justice. The vibrant reds, oranges, pinks, yellows, golds, whites, and a few previously undescribed hues make a pattern so striking... It looks like Roy G. Biv threw up.

Also, it's so wide at the bottom that you could wear a midriff shirt and no one would notice.

Yes, I really did wear it to work. Be jealous.

Halloween Memories

A long time ago, in a medical office building far, far, away...

As my regular readers know, before I went solo I worked for a large group called Humungous Neurology, Incorporated (HNI).

I left them for a lot of reasons, one of which (as is usually the case) was money. I won't go into too many details, but when I left my "contract-guaranteed" salary had been slashed by roughly 75% (to less than I'd made as a resident) because the money was needed for "the research budget."

By coincidence, my last day working for HNI happened to fall on Halloween.

So that day I came to the office (with a full schedule of patients) wearing an old pair of pants that I'd used to paint the house, a shirt with holes in it, a sock on only 1 foot, a pair of badly mismatched rundown shoes, and, for the pièce de résistance, this horribly hideous 70's era tie that I found while cleaning stuff at my grandparents' house.

When people asked me what my costume was, I told them I was an HNI neurologist, who couldn't afford decent clothes.

Repeating oneself... a symptom of...

Medication list from a patient (highlights added).

For those not in the medbiz, Donepazil is used for Alzheimer's disease.

Thank you, Gary!

Skool Nerse time

This is Mrs. Grumpy.


Kid wanders into my office.

Nurse Grumpy: "What's up?"

Kid: (wailing) "I was playing in the sandbox and got sand all over my hands and under my fingernails!"

Nurse Grumpy: "Have you tried washing your hands?"

Kid: "Ummm... No."

Nurse Grumpy: "Go wash them in my sink over there. Use soap."

(Kid washes hands)

Kid: "It's all better now!"

Nurse Grumpy: "Okay, go have fun."

Kid: "I'm going back to the sandbox. What a neat trick!"

Doctor's lounge, Sunday morning, 6:18 a.m.

Cardiologist: "The coffee machine is broken."

Neurosurgeon: "Ah shit. I really needed some, too."

Neurologist: "I don't think they come in on weekends to fix it, either."

Pulmonologist: "They don't. We're fucked."

Cardiologist: "Maybe we can do something..." (Opens front of machine).

Neurologist: "Wow, what a mess."

Neurosurgeon: "I think this thing that fell over holds the used grounds."

Neurologist: "Yeah." (dumps grounds in trash, rinses holder in sink, puts it back in machine).

Nothing happens.

Pulmonologist: "It's still not working."

Neurosurgeon: "Let me see... Here, look. The part that feeds the filter paper roll got doubled up and twisted. It's stuck."

Neurologist: "Hang on..." (pulls out filter paper roll) "Ah, okay, looks like it wasn't put in correctly. Let me turn it around and toss the jammed paper."

Machine starts gurgling.

Pulmonologist: "It's working! Yay! Coffee!"

(All get coffee)

Cardiologist: "That's amazing."

Neurosurgeon: "The coffee gadget?"

Cardiologist: "No. For the first time in medical history it was a neurosurgeon who made the correct diagnosis, and a neurologist who fixed it."

The pulmonologist blew her coffee all over the bagels.

Dog WIN!

Christmakuh is coming

So, if any of you guys have horrifying gift ideas you'd like to submit for this year's catalog, please send them in!

It's just a jump to the left

Seen in a cardiologist's hospital dictation:

Dear American Medical Association,

Thank you for the brochure I received from you and Mercedes-Benz, making me aware of the great car deals available to physicians.

I'm glad to see the AMA is still living in some sort of fairytale land where doctors have money trees growing in their yards. This sort of stereotype only fuels the already crappy image the public has of us.

Here's the reality: In 2013 (my worst year ever, due to several factors) Dr. Grumpy's solo practice salary came out to $99,354. That's working 60-70 hours per week, with 4 weeks of vacation.

Now, I'm NOT (emphasize NOT) complaining or bragging. I'm just stating this as a fact, to make a point. I know there are MANY people who'd be grateful to be able to make that. I'm thrilled to have a job I like that allows me to support my family.

But the reality is this: I drive a 14 year-old Nissan Maxima with the passenger door smashed in. Sending me a booklet telling me that, as a "qualified physician," I can save $1000 off a $92,000 S-Class sedan, $3000 off a $72,100 CLS-Class coupe, $4000 off a $116,000 CL-Class coupe, $3000 off a $114,200 G-Class SUV, or $3000 off a $106,700 SL-Class roadster... just shows me how fucking incredibly out-of-touch you guys are with the reality facing today's doctors.

Granted, I'm not a member of your organization. Honestly, I'd rather spend the $420 annual fee on my kids. To the best of my knowledge, an AMA membership gets me a journal I don't have time to read, discounted admission to an annual meeting I won't go to, and, obviously, a token discount on a car I can't afford. In fact, if I was a member, I'd be pretty pissed to find out this is what you were spending my annual fees on: getting me a deal on an imported car that costs more than I made last year.

American medicine is in a serious crisis right now. I'm not going to take political sides, as there are plenty of blogs for that. But my point here is that you guys are obviously clueless as to how much docs are really making.

Not to mention medical students. The next generation of docs are coming out of school $200,000 in debt. Residency pays maybe $40,000 a year, and they're at the ages where they're starting families, buying first homes, etc. Then they get to go earn practice salaries that (like mine) are dropping each year. So realistically the only "luxury automobile" they'll get to ride in... is a hearse.

Note to medical students- if you're doing this thinking you're going to get rich, just stop now and cut your losses. In fact, I'd get out regardless of why you're doing this.

But, I'm glad to see you AMA guys are on the ball. I'm sure there are SOME doctors out there who can blow that kind of money on a car (likely all on your board of directors) and it's reassuring to know you're doing something to benefit them.

The rest of us hard-working docs trying to practice ethical front-line medicine will stick with our old cars with the sides smashed in.

With a capital E

Mrs. Eword: "So, anyway, I want an MRI, and can do it today."

Dr. Grumpy: "I agree with getting one, but your insurance requires a pre-authorization. I'll have my staff get started on that, but it takes a few days and..."

Mrs. Eword: "I don't think you heard me. I want it NOW. While I'm here."

Dr. Grumpy: "Well, it has to be scheduled with an MRI facility and your insurance. I don't do them here."

Mrs. Eword: "What do you mean you don't do them here? You're a neurologist, aren't you?"

Dr. Grumpy: "Yes, and I order MRI's, but don't have the machine in my office. We use Local MRI, across the street and..."

Mrs. Eword: "I cannot believe this. What's that room I passed with the door closed down the hall here? There was a lot of noise. Isn't that your MRI?"

Dr. Grumpy: "Uh, that's the bathroom. They're replacing the sink's pipes today."

Mrs. Eword: "So you've been wasting my time this morning. Doesn't other peoples time mean anything to you? This is incredibly inconsiderate."

Dr. Grumpy: "I..."

Mrs. Eword: "I'll go elsewhere." (gets up, leaves)

Bite me

The kids had a healthy breakfast of Costco chocolate muffins yesterday, one of which had a minor defect.

But they felt the need to text it to me:

Details

I'm with a patient, when Mary knocks on my office door.

Mary: "Dr. Schnozz is on the phone, says he needs to talk to you ASAP."

Dr. Grumpy: "Excuse me..." grabs phone "This is Dr. Grumpy."

Dr. Schnozz: "Hi, we have a mutual patient, Mr. Platelet, and he was here with his wife a short while ago for his sinuses. Anyway, I'm concerned he needs you to work him in urgently."

Dr. Grumpy: "What's up? I mean, he was just here this morning at 9:00."

Dr. Schnozz: "Really? They didn't mention that. Anyway, he's weak on his left side, and I'm worried he had a stroke."

Dr. Grumpy: "He DID have a stroke. I had him in the hospital last week for it, and I saw him today in follow-up. He's weak on the left, and I ordered physical therapy."

Dr. Schnozz: "They didn't tell me that either. Never mind."

Memories... part 3

Dr. Tallahatchie went home. Because he was unable to use stairs for several weeks, and his apartment building didn't have an elevator, he needed to find a place to stay that was on the first floor.

Which, as it turned out, was my apartment.

So, 3 of us went to his place to haul crap he needed for a few weeks to survive, like some clothes and CD's, over to my abode.

As he waited in the car, he suddenly realized he'd forgotten to tell us to get something else he needed: his comic book collection. So, grabbing his crutches, he got out and hobbled over to the staircase. Since we didn't respond to his yelling, he decided to try ascending a few stairs... and fell. Landing on his recently broken leg.

The leg, fortunately, was covered in such a huge cast that it was indestructible. But it still hurt like hell. We ran down the stairs to help him back up.

He was pale and looked quite uncomfortable. Without saying a word he reached into a pocket and pulled out the newly-filled bottle of Percocet we'd just picked up. He poured several into his mouth, chewed them up and swallowed, then hobbled back to the car.

All he said then was "Wake me when we get to your place."

Memories... part 2

Dr. Tallahatchie, as anticipated, required a fairly lengthy surgical procedure. He'd broken his leg in 3 places, 1 of which was a compound fracture.

Even worse (from his view) was that they wouldn't let him smoke.

Recovery from this sort of thing is not painless. After surgery he was put on a morphine PCA pump. For those of you not in medicine, this is a gadget that delivers IV narcotics controlled by the hospital patient. You need more morphine? Press a button and it gives you some. The pump is programmed with a maximum amount and frequency you can receive, and is locked out with a security code.

20 years ago, however, the security codes were only 4 digits, and Dr. Tallahatchie had a photographic memory. After watching the nurse set it up, it took him only a few tries to hack it. Due to ongoing pain, he increased his morphine dose. This made him much more comfortable.

Nursing found him still breathing, but unable to be woken. The internal medicine service, comically, called for a neurology consult, and my colleague, Dr. Violet, told them exactly what the problem was.

So they took his PCA pump away. Since his vital signs were okay Violet didn't have the heart to use Narcan.

As a result of the overdose, the good doctor was now unable to pee, and so a foley catheter was ordered. His nurse started the procedure, only to be stopped when Dr. Tallahatchie suddenly became wide awake, sat-up, and yelled "HEY! THAT'S MY WINKIE!!!"

Although now more alert, he still couldn't run the water. And when the nurse came at him with the foley again, he asked her to give him a few minutes to "prepare himself."

She stepped out, and he frantically paged me, asking me to bring him a pair of sterile size 7 gloves. He didn't say why, but I realized what was up when I got there. He took the gloves and told me to distract the nurse for 5 more minutes. He wasn't going to let anyone touch his winkie.

When the nurse came back, she was stunned to see he'd put it in himself. Correctly.

Note: As of yesterday, Dr. Tallahatchie confirmed that (20 years later) he still smokes and drinks. He has not, however, attempted climbing a tree again.

Memories... part 1

One summer, a bunch of us neurology residents volunteered to work at a summer camp for teenagers with epilepsy.

This went well. Until the last day.

After the kids' bus had left, we learned the van coming for us had a mechanical issue, and would be delayed 4-5 hours.

So, with nothing better to do, we walked a mile to the nearest town, bought a shitload of cheap beer to carry back to camp, and got drunk. For those of you who are horrified, this is pretty standard. Medical residents are basically college students, but with more letters after their names.

This went well until our chief resident (Dr. Tallahatchie), the one in charge of showing us younger residents the proper way to do things and to lead by example... Decided to climb a large tree. This kind of decision (and the inevitable "Hey, everybody, watch this!") always seems to follow alcohol consumption. Especially when the person involved grew up in rural Mississippi.

In a bold display of intoxicated coordination, Dr. Tallahatchie climbed a tree about 15-20 feet up, then tried to swing across to a branch on it's neighbor. Which broke.

When we got to him, our chief resident was awake, still drunk, and had a broken bone sticking out of his right leg. The excessive alcohol probably helped, as he absently commented "boy, I sure fucked that up." He then pulled out a pack of cigarettes, began smoking, and pulled my beer out of my hand and finished it.

So we had several highly-trained medical people standing around, with no clue what to do for a compound fracture. I mean, if he'd had a stroke, or seizure, we might have had an idea. But we're neurologists, and don't know a damn thing about bones. None of us had a phone, either (this was the mid-90's) and the camp's office was locked. So, we threw some T-shirts on to absorb the blood, and Dr. Linn (who ran marathons often) bolted back to town to call an ambulance.

She also bought more beer.

When the paramedics arrived, they asked Dr. Tallahatchie to stop smoking for the ride back to Big City Hospital. He refused, and said he knew he'd be in the hospital for the next week and wouldn't be allowed to smoke there, so was going to keep puffing until they rolled him into ER. The sympathetic medic said "okay" and offered him a light. His partner went into the back of the truck to make sure their oxygen tank was closed and secured.

Our van didn't show up for another hour. We took Dr, Tallahatchie's suitcase with us. It was mostly full of comic books, which we read to pass the time.

To be continued...

Skool Nerse time

This is Mrs. Grumpy.

Last week I had a sick 7 year old girl in my office. While she was waiting for her aunt to come get her, I was reading some reports and swearing at them.

Nurse Grumpy: "Oh, Jeez! What's does this mean?"

Daisy Mae: "NURSE GRUMPY! You shouldn't swear like that!"

Nurse Grumpy: "Huh?"

Daisy Mae: "You said part of a word you're not supposed to say!"

Nurse Grumpy: "Oh, sorry, Daisy Mae."

(pause)

Daisy Mae: "Nurse Grumpy?"

Nurse Grumpy: "Yes?"

Daisy Mae: "I guess it could have been worse."

Nurse Grumpy: "I'm sure."

Daisy Mae: "I know the 'F' word."

Time

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

Mrs. Cephalgia: "Hi, I'm a patient of Dr. Grumpy's, and want to go off my migraine medication. I haven't had a migraine since I reached menopause, and don't think I need it anymore."

Annie: "Okay, let me open your chart... When did you become menopausal?"

Mrs. Cephalgia: "Tuesday."

Weekend reruns

Dr. Dickweed is an internist upstairs from me. He's been there since I moved into the building in 1997.

He's never referred to me. I'm polite. I've tried to talk to him in the elevator. When I started out years ago I went by his office asking for referrals. He coldly informed me that he doesn't trust, or refer to, physicians under 60 years old. Whatever. He's entitled to his opinion.

Anyway, Mary interrupted me today to say that Dr. Dickweed was on the phone. This was a first, so I picked up the phone.

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

Dr. Dickweed: "Grumpy, this is Dickweed. I just want you to know that I'm out of Grizzitor samples, and one of my patients needs some. I told her to come by your office to get them. Your staff doesn't need to schedule her for an appointment, and you don't need to see her. Just give her whatever Grizzitor samples you have."

Dr. Grumpy (somewhat taken aback by this kind request): "Dickweed, I'm out of Grizzitor samples. They stopped sampling it years ago."

Dr. Dickweed: "You young doctors are so fucking worthless." (click).

Quote of the day

"I'm allergic to all organisms that grow out of the ground."

Wednesday night, 10:27 p.m.

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

Mr. Molosser: "YEAH! You saw my daughter last week, she's in college up there, and I CAN'T BELIEVE WHAT YOU PRESCRIBED FOR HER MIGRAINES!!!"

Dr. Grumpy: "Um, sir, Migragone is a common treatment for migraines. It's been around for almost 20 years, and is pretty standard."

Mr. Molosser: "DON'T TELL ME THAT! I know medications! It's dangerous! It's experimental! I told her not to take it!"

Dr. Grumpy: "Are you a doctor?"

Mr. Molosser: "No, I manage a White Castle. And I'm having her find another neurologist. NOBODY treats my beautiful daughter like a guinea pig!"

Click

Parental abuse

My mom recently updated her phone to iOS 8, and texted to let me know.

"Those better be some damn fine scrubs!"

Seen on Amazon:

"Not just polyester and rayon, they're ARTISANAL polyester and rayon."

Thank you, Helle!

Family

I'm seeing the elderly Mrs. Cuticle, who's accompanied by her 2 adult daughters. We stopped talking for a few minutes so I could review records they'd brought, and...


Daughter 1: "When are you getting your nails done?"

Daughter 2: "I don't get my nails done. I've never liked it."

Daughter 1: "Well, you should. I mean, it's Autumn. I bet they could do them in some pretty seasonal colors."

Daughter 2: "I don't care, I don't want to get them done."

Daughter 1: "It helps them grow better."

Daughter 2: "It does not."

Daughter 1: "You'll look much nicer in church. It would really improve your appearance."

Daughter 2: "Are you calling me ugly?"

Daughter 1: "No, but you never..."

Daughter 2: "Zip it."

Daughter 1: "Mom, don't you think..."

Mrs. Cuticle: "Shut up. Why can't you ever NOT cause trouble?"

Daughter 1: "You always take her side."

Daughter 2: "Can you blame her?"

Mrs. Cuticle (whips out phone): "I'm calling Michael to give me a ride home. Both of you get out."

Daughter 1: "But Mom..."

Mrs. Cuticle: "Get out or you're grounded!"

Thursday afternoon whatever

Mrs. Dermtag: "There's a weird piece of skin on the back of my neck, so I'm having an autopsy tomorrow."

Dr. Grumpy: "You mean biopsy."

Mrs. Dermtag: "Whatever."

Reputation

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

Mr. Neuron: "Hi, I need to find out if I have brain atrophy. A friend said she saw something on TV about it."

Mary: "Okay, let me see... We have an appointment tomorrow afternoon at 4:00, or on Tuesday morning at 8:30, or..."

Mr. Neuron: "Can I just talk to the doc? Right now? On the phone?"

Mary: "You're not an established patient, sir, and he doesn't do that. I can certainly put you on the schedule, though."

Mr. Neuron: "But I don't need to come in. Can't he tell just from talking to me for a few minutes? Isn't checking for brain atrophy part of what neurologists do? It'll just take a few minutes, and I have time right now."

Mary: "I'm sorry, but you'll need to make an appointment to see the doctor. He doesn't do phone appointments, especially when he's never see you before."

(long pause)

Mr. Neuron: "You know, from seeing his name on the "Best Docs" list in Grumpyville Today magazine, I thought he'd be better than this."

(click)

Doctors behaving badly

I'm with a patient when Mary knocks on my door.


Mary: "Dr. Tanned is on the phone, says he needs to talk to you."

Dr. Grumpy: "Okay. Sorry, Mrs. Patient, let me take this call..." (picks up phone) "This is Ibee Grumpy."

Dr. Tanned: "Hi, Ibee. Sorry to interrupt you, but I just wanted you to know my wife works in home mortgages, and would like your business. Have you considered refinancing? She can get you a great APR."

Dr. Grumpy: "Are you kidding me?"

Dr. Tanned: "Not at all. She's saved a lot of people money on their house payments, and..."

Dr. Grumpy: "I'm with a patient. I have to go."

Dr. Tanned: "I'll fax you..."

I hung up.

Dear Medscape and Duke University,

Thank you for your recent invitation to take my practice "to the next level":

Your five courses sound enticing, exciting, and insomnia-curing. I'm sure they're ideal for doctors who wear suits every day and use phrases like "reaching out," "think outside the box," "patient empowerment," "corporate values" (an oxymoron if I've ever heard one), and "evidence-based paradigm." They probably make more money than I ever will.

I like how the price is down at the bottom in the smallest print. $899, with "per course" intentionally faded, hoping no one realizes this ads up to $4495.

Once upon a time, like many other doctors, I incurred a large educational debt. I don't want to do that again.

I like what I do, and have no interest in learning how to be a boardroom doctor who watches Powerpoint presentations, argues about what payment models are best for the shareholders, and denies medical coverage that might cut into his year-end bonus. I'd rather make less money and sit at the bedside of someone who needs my help.

Actually, the ad gives me the impression that the best way to make money in medicine these days... is to sell educational courses to doctors on how to make money. It reminds me of an old SCTV piece featuring the awesome Joe Flaherty as a huckster. He said something along the lines of "I came up with a great idea to get rich. I'm not going to tell you what it is, but if you send me $100, I'll mail you a pamphlet with some other ideas I had." (I couldn't find it on YouTube. If anyone knows where it is, send me the link and I'll embed it in here. No "Doctor Tongue's 3-D House of Stewardesses," please).

I've sat in enough classrooms in my time. I'll stay where I'm needed - with patients.

But, I have to thank you. Because after reading your ad I've already figured out a way I can save $4495.

See you next Tuesday... at the lab

Thank you, Webhill! 

Placement

"We still need to run that ad for the funeral home. How about next to the funny pages?"




Thank you, Michelle!

I should hope so

Seen in a hospital chart:

Yes, that's all it said. I didn't cut anything out.

Support the staff cardiologists

Seen in a reader's doctors lounge:

Thank you, Bill!

Memories...

One of my favorite drug reps asked me to share a story from the early days of her career.


I was calling on a cardiologist's office. They said the doctor needed samples, and would be out in a few minutes to sign for them.

Being a rep is a LOT of waiting in lobbies, and I'm used to it. There was a sweet looking elderly lady in a chair, who'd been asleep when I came in. When I was talking to the front desk she woke up, and when I stepped away said "that's a beautiful necklace."

It's my grandmother's necklace, and is an unusual piece. I'm quite proud of it. She asked me the story behind it, so I sat down  and chatted with her for a few minutes. Then I had to take a call from my partner. She picked up a magazine, but quickly dozed off again.

A few minutes went by, a patient left, and the doctor came up front. He signed for my samples, then cheerily called "Mrs. Dozer, come on back!"

Mrs. Dozer, however, was still asleep. The good doctor said "Can you give her a gentle tap? She's quite hard of hearing."

So I went over and softly shook her shoulder. "Mrs. Dozer, time for your appointment."

She fell, limply, out of the chair.

The doctor leaped over the front desk into the lobby and yelled for his nurse to call 911. In spite of his heroic efforts, however, Mrs. Dozer was gone.

I called my boss and told her I was going home. I didn't go back to work the next day, either. And I still have a visceral reaction when an elderly patient asks about my necklace.

Dear Kids,

While mom and I appreciate your efforts to save money, judging from your homework table I think things have gone a little too far:

Quarter added for scale

 We can, I assure you, afford to buy new pencils.

On call, Sunday morning, 2:38 a.m.

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

Mrs. Insomnia: "Hi, I'm a patient of Dr. Brain, I saw him once, about 5 years ago."

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

Mrs. Insomnia: "Well for the last year or two I've been a little forgetful. You know, losing my keys, or going into a room and forgetting why I went there."

Dr. Grumpy: "Okay..."

Mrs. Insomnia: "I had dinner with my daughter tonight, and she suggested that maybe somewhere in that time I might have had a stroke. I didn't think much of it, but now I'm really wondering, and thought I better call Dr. Brain to see if I should go to the emergency room."

Dr. Grumpy: "How long did you say this has been going on?"

Mrs. Insomnia: "At least one year, maybe two."

Dr. Grumpy: "I'd just call Dr. Brain on Monday."

(mumbled conversation in background)

Mrs. Insomnia: "My daughter thinks I should go to ER, and she should know, because she works for a dentist. Anyway, we're on our way there now."

Ummmmmm...

While browsing Google books yesterday I noticed this:

Stayin' Alive!

Seen in a hospital chart:


"She was subsequently discharged from hospice care due to failure of her symptoms to progress."

Tales from the trenches

Dr. Coogie writes in:

This morning I was on the computer, reading overnight notes on my patients. These were the nursing notes on one guy:

00:23  Patient yelled at nurse for pushing Dilaudid "too slow."

01:00  Patient running up & down hall yelling for more Dilaudid.

01:25  Patient called nurse an ugly bitch because she hadn't pushed Dilaudid faster.

02:00  Patient apologized for calling nurse an ugly bitch and asked for more Dilaudid. When informed he could only have it within the schedule set by pain management, he called her an ugly bitch again.

02:10  Patient ran to another nurse's station trying to get more Dilaudid.

02:30 Patient yelled at nurse for giving Dilaudid too slow, said "It's like giving me low octane fuel instead of high octane fuel."

02:40 On call physician notified of patient's behavior.


02:49 Patient seen by on-call physician, who informed the patient he would not be getting more pain medication than the pain specialists recommended.

03:40  Pt escorted back to room by security, who found him downstairs in ER demanding Dilaudid from staff there.



I absolutely LOVE this nurse.  I ran up and gave her a high-five before shift change.

Advice

Dr. Grumpy: "So, at your last visit I prescribed Quiloxitab for the symptoms. How's that working?"

Mr. Rummage: "Actually, I never took it. I decided to try herbal Oil de Baculum instead."

Dr. Grumpy: "Has it helped?"

Mr. Rummage: "Not yet, but the guy who told me to said it can take a few months."

Dr. Grumpy: "Is he a doctor?"

Mr. Rummage: "Not sure. My wife and I were out looking for a used suitcase this weekend, and he was having a garage sale."

"Old lamps, some dishes, paperbacks, medical advice... We got it all."

That should do it

Seen yesterday afternoon in a hospital chart:

For non-medical readers: the effective sedating dose of Valium is typically 5mg-10mg.

Red, Red, Wine

Dear Western Intermountain Neurological Organization,

A reader kindly forwarded your recent conference invitation.

I have to say, I had no idea the "intermountain" states even had their own neurology organization. Why such an organization is necessary is beyond me, as I'm not aware of groups such as "Neurological Association of States that begin with an N" or "United Neurologists of Civil War Border States" or even "Neurologists Organized in Cities with Fewer than 10 Letters in Their Names."

But, I digress.

Anyway, what caught my eye on the invite was your acronym:

Generally, a title like that doesn't bring up images of a bunch of neurologists sitting in a darkened lecture hall learning about the latest research in mitochondrial disorders. Liver transplants, maybe.

Your site name, winomeeting.org, isn't bad, either. Sounds like an organization I'm ready to join after a crappy day at work. Or night on call. Or... Screw it, I'm ready to join now, provided your standards are above Night Train Express and Thunderbird. But I'm willing to negotiate.

I see this year's meeting is being held in Salt Lake City, generally not a place I think of for its widespread availability of alcoholic beverages. The last time I was there (2012) I saw a bleary-eyed dude standing on a street corner drinking from a bottle wrapped in a paper bag... and it was milk. I'm guessing he was an RM re-adjusting to big city life.

Your site says the meeting will "stimulate your thinking" and that my $150 registration fee includes breakfast and lunch. Will funeral potatoes be served? Fry Sauce? Green Jello? It would also be helpful if you noted what stimulants and beverage vintages are included with the meals, preferably ones I can mix with Diet Coke.

The idea of a room full of docs wearing nametags that say "WINO" is also entertaining. Especially if the featured speaker is unshaven, slurring, shabbily dressed, and tremulous.

The site also has this price list:

I have no idea which companies want to set up a booth at a WINO meeting, but I'd love to see what they're wearing. I'm imagining guys who look like they just spent the night sleeping on a bench in Temple Square (but without the black name tag) sampling beverages that can double as lighter fluid. Also, I think it would be cool to watch sales reps for Campral and Two Buck Chuck working the crowd together.

Lastly, while I don't live anywhere near a mountain, I'd still like to join your organization. Because nothing would be more impressive than to have a framed certificate that says "WINO" in big letters hanging amongst my diplomas.

It may actually improve my Yelp ratings.

Thank you, Mike!

Weekend reruns

Mrs. Grumpy had a meeting tonight, so I had to feed the kids. Fortunately for me, a Big Pharma, Inc. drug rep brought lunch to the office, and there were a lot of leftovers. So this afternoon I grabbed a bag out of the cabinet (with the Big Pharma, Inc. logo on it), tossed the leftovers in, and headed for my car.

Passing a cardiologist's office on my way to the elevator, a female rep I'd never seen before, wearing a Big Pharma, Inc. name tag, came out of his office. We made eye contact, and I nodded, smiled, and continued on my way.

Only to be stopped after another few steps by her saying loudly, "Oh MY GOD! What are you doing?"

I turned around to find Ms. Rep looking at me, horrified. "Excuse me?" I said.

Ms. Rep: "Are you taking food from a doctor's office?"

Dr. Grumpy: "Um, yeah, is that okay?"

Ms. Rep: "NO! It's rude! It's unacceptable and inappropriate! And look at the way you're dressed!" (I tend to be on the casual side) "You don't even have a name tag! What are the corporate people teaching you new reps, anyway?"

Before I could answer she went on: "I'm sorry. I suppose this isn't your fault. The training people must be slacking off." She offered me her hand. "You must be new. I'm Stacey, from our cardiology marketing division."

I shook her hand. "I'm Dr. Grumpy, from the neurology division down the hall."

Stacey, from the cardiology marketing division, somehow looked even more horrified now. After a few stuttering attempts at saying something she answered her cell phone (which hadn't rung), mumbled "nice to meet you" and ran into the stairwell.

In that case, I think you're publishable

Patient quote of the day:

"I'm allergic to all known amino acids and proteins."

"Swordfish"

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

Mr. Beef: "Hi, I need to get in today."

Mary: "We have nothing today. But tomorrow..."

Mr. Beef: "But I want to be seen today!"

Mary: "We're completely booked."

Mr. Beef: "But don't you have secret slots? Like the secret menu at Arby's or something? Is there a password?"

Hawaiian vacation, day 11

Sigh. Today we packed up and headed back to reality, work, and jobs.

The dichotomy at the Maui airport is striking. People getting off planes, bubbly and thrilled to be on vacation, and a sullen-looking group sitting quietly at the departure gates waiting to go home. Even the relaxed restroom picture stick people seem to be mocking you.

While walking along I noticed that a local gynecologist had set up shop in the terminal:

"What on Earth is going on in there?!!!"

Better yet, it was the mens room:

"Okay, now I'm REALLY confused."

 The flight home was quiet. But it brings you back to what really makes your family whole again.
 

And that's the way it is. Aloha!

Hawaiian vacation, day 10

My favorite memory from my first Maui trip (1973) is of a dog.

Dad was driving us down some side street while Mom looked at a map (yes, kids, that's what people did before GPS). As we rolled along, we came to a Golden Retriever lying across the middle of the road. The street was narrow, with no way around him.

So Dad drove on, figuring at some point the dog would get out of the way. No such luck. He was, apparently, quite comfortable.

As we approached, Fido raised his head off the ground to look the car over... Then put it back down.

Dad stuck his head out the window and yelled. No response.

He honked the horn several times. Fido's left ear twitched.

Finally, Mom got out of the car and went around to nudge him. He rolled over on his back with an "OH BOY! YOU'RE GOING TO RUB MY BELLY" look.

Finally, Dad gave up. He backed slowly out of the side street and turned around to find another route. My sister and I watched as a bird landed on the sidewalk and Fido took off after it.

As it turns out, this is pretty much the way dogs are on Maui. Nothing fazes them. No matter how laid back you think your dog is, a dog on Maui will make him seem high-strung. They are remarkably mellow. The scuba place we dived with had a dog named Sarge, who pretty much had the run of the strip mall.

He spent the day wandering around the parking lot and in & out shops there, and no one cared. In fact, he seemed to have a small fan club, like the postman and others, who tossed him treats as they went by.

Equally important, he also provided surrogate dog services to people whose pets were back home. And was more than happy to do so.

Marie and Sarge. He looks vicious, huh?

After scuba diving, Marie asked if we could go to Subway for lunch. Marie's favorite sandwich there (roast beef, tuna, and cheese) always raises a few eyebrows.

Counter lady: "What can I get you?"

Marie: "I'll have roast beef and tuna, with cheese."

Counter lady: "Sorry. Can't do that. It's against company policy to combine roast beef and tuna."

Marie: "But I get that at home"

Counter Lady: "Well, they should know better."

Marie: "You can't do it?"

Counter Lady: "No. It's probably a health code violation or something, too."

Marie: "Let's go, Daddy."


We ended up down the street at L&L for a plate lunch.This is a Hawaiian thing. Regardless of what you order, it always comes with 2 scoops of white rice and one of macaroni salad.

Down the street from our condo is a restaurant with the unusual name of Slappy Cakes. This immediately brings to mind an image of getting smacked by the hostess when you go in.

Curious, I looked them up online. The theme is that you cook your own pancakes. I, personally, have never understood this concept. If I'm going out to eat, I'm paying for you to make it for me. I'll stay home if I want to cook.

The setup consists of a large griddle set in the middle of each table, making me imagine someone getting 3rd degree burns while passing the syrup. Their menu, however, does list the admirable feature of serving cocktails at breakfast for those who like to watch Matt Lauer while blitzed. One is called the "Slappy Screw," which sounds like something a guy would spend $50 on in the Honolulu red-light district.

They also feature such heart-healthy fare as chicken-fried bacon and pork-belly benedict. Like every place here, they also have a Loco Moco (called the Slappy Moco). This is a pile of white rice, with a hamburger patty on top, then mushroom gravy, then a fried egg.

At the bottom of Slappy's menu is this great "We told you so, so don't sue us" legal disclaimer:

Tabletop griddles are hot! Please use carefully at your own risk. For safety reasons, children must stay seated and not reach across griddle. 

Because, you know, small children ALWAYS do exactly as they're told.


This afternoon, while hanging out in the lobby, Frank wandered over to one of those tourist brochure displays. After a few minutes he pulled one out, brought it over to me, and asked "Dad, can we go to this luau?"

Dude. I'd be staring, too.

This is part of the fun of traveling with teenage boys. Pretty much EVERYTHING gets their attention. Even ceiling lights.

And that's the lei it is.


Disclaimer - none of the above restaurants paid me to write about them. But I am, however, for sale. Someone, please, buy me.

Hawaiian vacation, day 9

My pill containers are depressing, reminding me that we only have 2 more days of vacation left.

Why yes, they were given to me by a drug rep.

Today this was lying next to our rental car. Apparently someone had a wild time in the parking garage.

Yes, they're panties. There was also a used condom, but I didn't think you'd want to see that.

This morning we went to Iao Valley. This is an absolutely stunning area, with mountains covered by greenery. The area gets 386" (9.8m) of rain per year, creating several large streams that run outwards through the island to the sea. The walking path through the area is beautiful. The weather varies from misty to sunny, and often changes from one to the other at 15 minute intervals.

The area was considered sacred by the Hawaiians, with several kings being buried in unknown graves.

The central spire (Iao Needle, above) is a 1200' ridge in the center of the park. The ancient Hawaiian's believed it was the god Kanaloa's penis. This is not something you'll learn at the Enchanted Tiki Room.

In 1790 a large battle, Kepaniwai, was fought here during the wars of Kamehameha I. So many died that their bodies blocked the out-flowing streams and turned them red. The name of the battle literally means "the damming of the waters."

Like the waters of Pearl Harbor, or fields of Verdun, the area is so peaceful today that it's hard to believe what once happened there.

Driving back to the condo, we admired some of Maui's roadside scenery.

Hawaii, though far from the mainland, still has a lot in common. For example, during their recent election, not 1 but 2 of the 7 candidates running for mayor were arrested. The first, Nelson Waikiki Jr., was wanted on charges of fraud and violating bail. He'd apparently been managing to avoid the law, but, in the spirit of the race, showed up at the candidates debate. The police politely allowed him to finish speaking before hauling him away.

The second was stopped for driving without a license plate AND talking on his cell phone (both illegal in Hawaii). He told police that neither law applied to him because, well, they just didn't (why you'd want to run for office if you don't even believe in the office is beyond me). He then drove away, was later stopped again, and tried to flee on foot. Ignoring several warnings to stop, he ended up getting tased.

Just another day in paradise.

Stayin' Alive!

Leigh sent this pic in. She said she stopped to visit her parents' graves last weekend, and the cemetery had a banner up...

"We'll also be reenacting the video from 'Thriller'."

Thank you, Leigh!

Hawaiian vacation, day 8

This morning I checked on the dogs.


Phone girl: "Thank you for calling Burgoo Animal Care."

Dr. Grumpy: "Hi, this is Ibee Grumpy, calling to see how Snowball and Mello are doing?"

Phone Girl: "Snowball and Mello... I think they went home yesterday."

Dr. Grumpy: "WHAT?!!!"

Phone Girl: "Yeah, they... Hang on, let me check with Casey."

(Panicked, I'm put on hold, listening to horrible, unseasonal, Jingle Dogs Christmas carols)

Phone Girl: "Okay, they're here. I had them mixed up with someone else's."

Dr. Grumpy: "Thank you."

Phone Girl: "They're going to the bathroom and everything."



Whaler's Village is an outdoor shopping center on Kaanapali. It's been there a long time. In fact, I saw it on my first trip in 1973. My mother made me keep a diary, and my entry for that day was "Today we saw the skeleton of a whale." Obviously, I was impressed. The skeleton is still there.

Scattered among the stores are some interesting displays about whales, and they have a museum about whales and whaling on the 3rd floor. This kind of stuff fascinates me. These are the biggest living creatures today, and the Blue Whale is the largest living animal EVER on Earth.

How big is it? Some have been measured at nearly 100 feet (30m) long and 195 tons.

Yes, that's you on the upper right. And the flippers make you look bigger.

But the really cool thing is this: the whaling museum has a statue of a strange creature in the corner, which looked like a cross between a lizard and a medium-sized dog. It's a long-extinct animal called Pakicetus that lived on the shores of what's now Pakistan 50 million years ago. This is it, also with Homo sapiens:

Somewhere along the way, dinky Pakicetus returned to the ocean, adapted, branched off... and became the cetaceans (dolphins and whales) of today. Including the biggest living creature on Earth.


The rest of the mall, in keeping with Lahaina's history as a major Pacific whaling center, (sarcasm) is a collection of souvenir shops, restaurants, expensive clothing, jewelry, & shoe stores, and (inevitably) one of the ubiquitous ABC Stores.

One overpriced boutique apparently caters to individuals with grossly asymmetric arm lengths (and, on your left, missing a finger):

"I had a half-scholarship for basketball in college"

If you have teenage boys, by the way, KEEP THEM AWAY from ABC stores. Oh, sure, they'll tell you they want to buy a Diet Coke, or sarong for Aunt Thelma, or a souvenir toothpick holder, but the real reason is that ABC sells picture postcards of young, topless, Hawaiian women. And calenders. And probably stained glass windows. It's kind of an all-purpose Hawaiian boob center. In the interests of fairness, however, they do sell similarly themed stuff with hunky Polynesian guys, too.

In the 1980's, during one of our family trips here, I routinely walked over to an ABC and bought topless postcards. A LOT of them. I figured, being a college guy heading off to medical school, it would be fun to have some to use over the next few years to mail to friends around the country as a joke.

It's been over 25 years since then. There's still a pile of unused cards from that batch in my desk at home. In fact, here it is:

I put a less-revealing one on top

As you can see, the stack is still almost an inch high. So, the take-home lesson here guys is never over-buy the topless postcards at ABC. As good as the idea may sound at the time, you'll never get rid of them. I mean, who the hell sends postcards anymore, anyway? Some day, while settling my estate, the kids are going to wonder why the hell I have a bunch of these in my desk. Frank and Craig will likely have their own stockpiles by that time. And won't be able to get rid of theirs, either.

We went for Mexican food tonight. Craig is convinced lettuce is the most deadly substance on Earth. It's not enough for him simply not to eat it. He actually has to scrape it off his plate so it doesn't contaminate the other comestibles.

And that's the way it is.

Hawaiian vacation, day 7

Today we went kayaking.

This was Craig's idea, and I got suckered into it. Physical exertion is generally not my idea of a vacation. I tried telling him it would mess up his hair, which (surprisingly), didn't dissuade him.

I called a place and made a reservation. They told me to meet "the guy” on the beach at mile post 7. So, at the ungodly vacation hour of 6:30 a.m we arrived, only to find 3 different kayaking outfits waiting there for their customers.

I went up to the guy closest to us, and before I could say anything he glanced up from his clipboard and said "Dude, are you the Tarahashi family, from Tokyo?"

I don't even look vaguely Asian and was briefly taken aback. He apparently took the pause to mean I'm either deaf, don't understand English, or both. So he repeated the question, loudly, in halting Japanese.

"What do you do when you come to a yellow light?"

I said, "No, we're the Grumpy family, from Ohio. Are we on your list?”

He flipped through some pages, and said "No, but I think I remember your name from the invoice I left at home" and tossed the clipboard into a rusted out Toyota pick-up. "I'm Skeeter. Let's get you guys some kayaks out of the back."

So I followed Skeeter. He was skinny, deeply tanned, and had long blonde dreadlocks. He looked like a SoCal dude, though later told us he was from Hilo, on the Big Island. He smelled like marijuana, not in an I-just-smoked-some way but more like he uses it frequently at home, and so the smell has permeated everything.

At some point I assume the Tarahashi family showed up, and probably went with some other kayak outfit under our reservation.

Skeeter dragged 3 kayaks out of the pick-up bed, and gave us a 10 second lecture on rowing. The twins, as always, went together, and Frank and I paired up. Skeeter headed out with some guy whose name was never given and magically appeared from under the truck, with motor oil on his chest.

Off we went, paddling away down the Maui coastline. Occasionally Skeeter would point out interesting fish, or birds, or clouds, or mountains, or UFO's.

After about 30 minutes he noticed a sea turtle leisurely drifting near us, and yelled "Hey Mr. Turtle, Dude! How's it going?"

Mr. Turtle Dude kept coming toward us, then dived and swam under me and Frank's kayak. We both leaned to our right to watch him go by, immediately capsizing the boat and dumping us both in the Pacific.

As soon as we came up, Frank began screaming that he'd lost his glasses. Skeeter jumped out of his boat, and he and I both dove down to the coral several times to look for them. After our 3rd or 4th dive Frank realized they were still around his neck.

Mr. Turtle Dude, by this time, had given up on the primate entertainment, and moved on, with as contemptuous a look back at us as can be managed without facial muscles.


We continued paddling. This is SO not my thing. I got a blister on my thumb, FFS.

As we cruised along the coast, the twins got a little too close and were caught in the breaking surf. Frank, Skeeter, Motor Oil, and I watched helplessly as they were tossed about, then thrown onto the beach as both of them leaped out at the last second. The kayak flipped over a few times before it came to rest next to some rocks.

Craig, using his Boy Scout training, made several attempts to launch the boat, without success. Each time it got pushed back by the waves, or turned over. The attempts ended when he accidentally dropped one end on Marie's foot, and she slugged him. Then they began yelling, throwing sand, and screaming at each other as to whose fault it was that they were now trapped on a beach in the middle of nowhere (20 feet from a major highway, with cars whizzing by) and were now going to die and I TOLD YOU THIS WAS GOING TO BE THE WORST VACATION EVER!!!

Skeeter jumped out of his boat, and swam ashore. He separated them, relaunched their kayak, swam along pulling it until they were outside the breakers, and then got back in his own boat.

You better believe I gave him a decent tip.

When we finally got back to the condo, Mrs. Grumpy asked us how it was. I tried to convey my horrible suffering at having a blister on my thumb, but she unsympathetically didn't give a shit. Instead, she ignored me and asked the kids.

Marie said "It was fun! Craig and I got shipwrecked!"