Neurology, 2015

Dr. Grumpy: "Okay, Annie will set the MRI up for you, and then I'll see you back when we have the results. Any questions on this?"

Ms. Valtrex: "Um, maybe not related to the other symptoms, but I have some bumps on my skin, you know, down there, that have fluid coming out of them. Can you look at them for me?"

Pharma radio

Apparently, the satellite radio had to truncate the title of the classic song "Love is Like Oxygen" (Sweet, 1978) to fit the display. And, in 2015, it brings up a whole new meaning:

Really makes you think twice about the chorus "you get too much, you get too high," huh?

Thank you, Webhill!

Memories...

In the early 90's I got a coveted med school rotation at a major American medical academic center.

The main reason I was selected over other applicants is that there weren't any. At the time of year I applied for, no sane person would be anywhere near that city. So I was the only medical student. Half their staff, for that matter, left town that month, too.

In fact, the only reason I went there is because my grandparents lived in the area at that time, so I could stay with them.

They also didn't have any residents rotating that month. Or fellows. So I, Ibee Grumpy, 4th year medical student... was it.

Because of this surprising circumstance, they gave me an actual pass to park in THE DOCTOR'S LOT. I mean, I do that now, all the time. But back then this was SOMETHING BIG. Like the executive bathroom. Normally, at most schools, med students aren't allowed to park anywhere that isn't at least a 30 minute walk away, going through a neighborhood where heavily armed police are afraid to patrol.

Needless to say, I was excited. I didn't have the world's best car, but it was nice and in good shape. It was a white 1988 Mercury Cougar, and I was close enough to my teen years that I washed and waxed it regularly.

Unfortunately, while driving to that city I sideswiped a guardrail, and smashed in the side. Since it was now impossible to open the driver's side door, the Cougar went to the dealer's repair shop. Where I was told it would be a few weeks because the staff was on vacation, my insurance was a bitch to work with, I didn't have the money to make it a rush job, etc.

Fortunately (or unfortunately) my grandfather had just given up his driver's license, so didn't need his car anymore. In fact, he'd been getting ready to sell it, including getting a fresh paint job. He graciously told me it was mine for the duration of the visit.

Unfortunately, it was a 1977 Chrysler LeBaron.

 

Now, these days I'm not a car snob. Having a job and kids can do that to you. So now I drive around in a 2000 Maxima with the passenger side smashed in.

Back then, however, I was a low-grade car snob. Part of being a teenage boy in America is going through a car-crazy phase, which I did. For a few years I read Motor Trend religiously every month, and knew obscure details about every make & model built. Today I don't even know them about my own car.

But I digress. Back to the story.

For those of you too young to remember, a feature of the era was a chain of low-cost auto body shops named "Earl Scheib." They were known for these ads (which, at the time, were everywhere).

In my grandparent's city, the franchise was known for that ad being the bait. When you showed up, you found the deal price only applied to a handful of truly hideous colors that no one in their right mind would want. If you actually desired a halfway decent paint scheme, you had to pay a lot more. The place also had a tendency to overspray paint on places it normally wasn't found, like windshields, chrome trim, tires, dashboards, seat belts, vinyl roofs, headlights, and innocent bystanders.

Anyway.

In trying to spruce up the car to sell it, my grandfather took it to Earl Scheib, and just picked out the cheapest color. The fact that he was color-blind likely didn't help.

So the LeBaron was yellow.

Not just plain yellow, but Earl Scheib extra-glossy electric-neon-flourescent-banana-can-be-seen-from-the-space-shuttle yellow.

It looked like an irradiated taxi on the way to a demolition derby.

"It's like, 'how much more yellow could this be?' and the answer is 'None. None more yellow.'""

The car, as I discovered, also had a tendency to backfire, quite loudly, at random intervals.

And, one morning 25 years ago, I pulled this contraption into the doctor's parking lot at a prestigious, internationally renowned, medical center. As I tried to find a space without anything on either side (I was terrified of scratching some VIP's car) it backfired twice, causing the well-dressed specialists walking into the building to drop and hide behind concrete walls (a reasonable precaution in that area).

I parked there the next morning, too.

On my second day I was told that "due to an administrative error" I'd been given a pass to the wrong lot, and had to park in the medical student's lot, 8 blocks a way, in a high-crime area, behind a dumpster, down by the river.

Not having any choice, I did so.

In an area with a high rate of car theft and vandalism, The LeBaron went untouched during my entire rotation. Except for someone writing "Yellow POS" in the dirt on the back window.

Finders keepers

Mary: “Dr. Grumpy’s office, this is Mary.”

Miss Presson: “Hi, this is Lee Presson, I had an appointment with Dr. Grumpy about an hour ago.”

Mary: “Sure. What’s up?”

Miss Presson: “Did you guys find one of my fingernails?”

Mary: “Um… No… You lost a fingernail?”

Miss Presson: “Yeah. I put on a fake set this morning that I got at Cheapshit Chic. And one is missing. I think I last saw it in your lobby. They have, like, leopard spots on them.”

Mary: “Well, I haven’t seen one…”

Miss Presson: “Can you please look?”

Mary: “Okay… Hang on, let me put you on hold.”


Mary walks out to the lobby, and, I swear, finds the fingernail.


Mary: “All right, I have it. It’s stuck to the cover of this week’s People magazine.”

Miss Presson: “Great, I’ll be by in about 10 minutes. Will you hold it for me?”

Mary: “You’re coming back to get a fake fingernail?”

Miss Presson: “Yeah, I’m meeting a blind date for lunch. I don’t want him to think there’s something wrong with me that I only have 9 fingernails.”

Mary: “Okay... It’s here up front. In fact, you can take the magazine attached to it, too.”

Miss Presson: “Thanks. Hey, do you guys have any super glue?"

Topsy-Turvy

Dear News360,

I wanted to thank you for your "Health Tips" article yesterday on pelvic lymph node dissection for prostate cancer. The graphic you featured, in particular, was quite helpful:

"What's that noise? Frank Netter rolling over."

Now, I have to admit I'm over 20 years removed from anatomy class, and being a neurologist don't really deal with dem lymph node thingies too much.

But, to the best of my recollection, the area shown in your pic is NOT (unless you're Linda Lovelace) where you'll generally find the pelvic lymph nodes, regardless of whether or not you possess a prostate.

I wasn't too sure, though. I mean, medicine is a field that's constantly changing, so I asked a friend who's an OB/GYN, since I figured she deals with that area (though not for prostate issues) more than I ever will. Her response (after "Are you fucking kidding me?") was: "Along the iliac veins." That's medicalese for "they're in the pelvis, you dork. Duh."

I also like your phrase "doors of the prostate." Honestly, I'm not sure how to take that. While I own a prostate, I've never really thought of it in terms of having doors, windows, or pretty much any other standard features of building architecture.

There's also your use of the word "unfold" to mean "spread" or "metastasize." It makes it sound like cancer is really a form of malignant laundry (although my colleague Webhill insists that all laundry is malignant).

For that matter, I wasn't sure about the way the rest of the article was written, either. While your writer appears to be using a pen name, I have to wonder who's really dictating the text.

Yours truly,

I. B. Grumpy, M.D.

Thank you, Diver Dan!

Beware of the Dragon

Seen in a hospital chart:

Math

At a recent Continuing Medical Education course, the following slide was presented:

"And the rest become zombies."

Thank you, Diver Dan!

Rockin' down the highway

Dr. Grumpy: "At your last visit you were having migraines with orgasm, and so I started you on medication. Has it helped?"

Mr. Class: "I think so, I mean, I had my girlfriend suck me off on the drive here, and everything was okay."

Dr. Grumpy: (completely at a loss for words) "Um..."

Mr. Class: "Also, can you write a note to get me out of a traffic ticket?"

Things that make me grumpy

Recently, Marie's 8th grade girls basketball team won their division's state championship. It was the first time Wingnut School had ever won a state title of any sort. And what recognition did they get?

Zero. Zilch. Zip. Nada. Nothing.

Now, I'm not expecting a parade, or a call from the governor (generally only death row inmates want the latter). I mean, this is just 8th grade. But some acknowledgement outside the team (and us proud parents) would be nice.

In the morning announcements, where they routinely read off scores from boys sports (basketball, baseball, jacks, team scrabble) and upcoming chess club matches, were the girls winning the state tournament even mentioned? Nope.

When the boys basketball team vanquished their arch rival, Lockjaw Middle School 34-32, Wingnut put up a banner the next morning and had a pep rally over lunch. The girls beat Lockjaw 63-40, and weren't even mentioned in the announcements. Or school paper. Or PTA bulletin. Or pretty much anything.

The boys finished the season 8-6, their first non-losing season in 8 years (though didn't make the playoffs), and this fact was announced several times on the school's Twitter account, with pictures. The girls were undefeated at 14-0, and then swept the division's playoffs 6-0. The only time the school mentioned them on the Twitter account all year was before the season even started, to show them trying on their newly redesigned jerseys (which the parents paid for).

The sad part is that the people responsible for this sexist ignorance don't even realize what they're doing. It's 3 secretaries and a vice-principal who write up the morning announcements and plan events. The Principal herself doesn't want to be bothered with such trivial things.

I called and complained yesterday, and was told that a banner about the championship would be hung in the gym "sometime over the summer, when maintenance gets a chance." When school isn't in session.

Of course, they're not alone.

A few times each summer I take Marie and drive the few hours to see the nearest WNBA team play. I think the games are great. Personally, I'd say they're as exciting and competitive as the NBA, with a lot more teamwork and fewer ego conflicts. If you enjoy basketball, and haven't seen a WNBA game, I'd go.

But the same issues are there. The arena is maybe half-full, in spite of the quality of the play. Maybe Americans, by nature, just don't care about women's sports. For a country that often tries to pride itself on equality, women's basketball is far more popular elsewhere. The vast majority of WNBA players work year-round, playing here in the Summer and overseas the rest of the year to earn a living.

Not to mention salaries. In the NBA, pretty much the league minimum is $900,000 per year. And that goes to the guy who rides the bench all season.

In the WNBA? One of the league's biggest stars, Diana Taurasi, makes... $107,000 a year. While certainly not a small amount, Ms. Taurasi is actually taking the 2015 season off from her WNBA team to play in Russia for $1.5 million. And who can blame her?

It's sad to see that, at age 13, my daughter is already learning how much the accomplishments of a talented group of young women can mean. Which is, apparently, not much.

Mary's desk

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

Mrs. Urgent: "My daughter needs to get in to see Dr. Grumpy right away!"

Mary: "Okay. We have an opening on ..."

Mrs. Urgent: "It's an emergency. She needs to be seen urgently."

Mary: "Okay, we can see her tomorrow at..."

Mrs. Urgent: "No, she can only do a Friday, because of her school schedule.”

Mary: "Okay... Well, this Friday, at 3:15 she can..."

Mrs. Urgent: "No, that won't work. She works on Friday afternoons. The only time she can come in is on a Friday, before noon. But it's really urgent."

Mary: "All right, let me look... Our next Friday morning opening is in 2 weeks on..."

Mrs. Urgent: "Didn't you hear me earlier? This is urgent! She needs to get in right away!"

Mary: "Yes, and like I said, we do have an opening tomorrow at..."

Mrs. Urgent: "Obviously you're not listening, don't care, and aren't willing to help her."

Click

Catch-22

From a medication denial fax I received last week:

Define "valuable"

Invitation a reader recently received for a market research survey:

Thank you, Dr. M!

Things that make me grumpy

This is an actual note I had to dictate today.


Dear Dr. Intern,

Mrs. Payne returns today. I haven't seen her since March.

She says she never had any of the tests I ordered, and transferred care to another neurologist in North Grumpyville. She says she was unhappy with me and my staff, and didn't want to continue care here.

She continues to have a constant headache and intermittent arm tremors. She says the other neurologist is managing all these symptoms with medication, and has ordered further studies. I wasn’t previously aware of any of this.

The reason she comes in today is because she needs disability forms completed, but the other neurologist is on vacation for the next 2 weeks. Therefore she made this appointment with me to have them filled out since they're due before then. She's then planning to return to the other neurologist for future care.


Yes, Mrs. Payne, I did send that to your internist.

I'm sorry you felt it was unreasonable of me to refuse your request, but in good conscience I can't fill out forms on a patient I'm not treating. I'm sure some less ethical doc would have agreed to do so, and billed you $50 for it, but I won't even play that game. It just isn't worth it to me.

I didn't charge for your ludicrous visit, either. I probably could, but if it gets audited, or the insurance (or you) complain, I'm sure doing so would make me look bad. So I took a loss on the 30 minutes you'd booked "to discuss my case."

I'm not offended you don't like me. You learn early on in this job that you can't please everyone. But if you change docs, don't waste my time coming back here for bullshit reasons.

There simply aren't enough hours in my day as it is, and life is too short for that kind of crap.

Yours truly,

Ibee Grumpy, M.D.

Research

"In other words, do not try this at home."

Thank you, Webhill!

Can't hold it back anymore

Does your daughter love "Frozen"? Does she dream of being friends with Elsa? Has she ever told you that, when she grows up, she wants to be a neurosurgeon?


Well, now she can have it all!

Love the toenail polish

 

Yes, for the first time in forever, your little princess can be the attending neurosurgeon on call at Arendelle Regional (the area's only Trauma One center), when the queen presents with a hemiparesis after a skiing accident. She has an evolving epidural hematoma, and only YOU can save her!

Of course, neurosurgery isn't all brains (in fact, I've known a few neurosurgeons that may not have one at all). You could also be the pediatric spine specialist working when the royal family presents to discuss their young daughter's scoliosis.

I'm not making this up. Google it yourself.

Helluva pic, isn't it? Apparently someone forgot to call anesthesia before they started cutting. Also, if your surgery scars look like this, I'd probably find a surgeon who isn't in DT's during the procedure. Granted, some weekends that can be a challenge.

Oh, wait, now the anesthesiologist came in, so we can proceed. Who needs to intubate when you've got a binkie?

"A few Harrington rods and we'll have the spine frozen in place. Get it? Frozen?"

Of course, maybe brains and backs aren't your thing. Perhaps you prefer to work at the opposite end of the body. Well, there's a game for that, too:

"He does look a lot like Kristoff, Anna, but I swear it's just a coincidence."

Isn't that just wonderful? I mean, if you're sick of this shitty winter weather, here's your chance for payback with a big honking episiotomy. And with Elsa, you don't have to worry about warming the speculum. She's probably colder than it is, and it's not like the cold ever bothered her... Anyway.


Of course, the fun is only beginning with these skanky games. What else can give your little princess a healthy idea for a female role model than seeing a heavily-pregnant member of Arendelle's royalty doing housework?

"Hey, babe, can you get me a beer while you're up? Oh, and Sven shit in the hall, when you get a chance."

Apparently the pregnant midriff look is what's hot in Arendelle these days (probably the only thing that is). I'm pretty sure none of these sites are officially endorsed by Disney. And that one definitely isn't sanctioned by Kate, Duchess of Cambridge, either.


Of course, there's always the chance that Elsa will get sick of vacuuming and deck the cad (Prince Hans, I bet) who did this to her. One good punch and he's headed back to the Southern Isles. Let's just hope she doesn't hit him too hard or else...

"Hey! What the fuck is Dora doing in the picture?"

It may be expected that you kiss the Queen's hand when meeting her... But I'd have to decline. Looking at those sores, I don't know where it's been. For that matter, I don't want to know, either. Especially if it's reindeer Brucellosis.


No matter what happens, Elsa is likely going to need time to get back to normal. Which brings us too...

"Wait. Why the hell is there a paintbrush in here? Some horrible crafting accident?"

 And, I think it's about time to... let it go.
 

Thank you, Craig, for bringing these horrifying games to my attention.

Quote du jour

"My Dad suffered a fatal stroke when he was 68, but lived for another 15 years."

Annie's desk

Ms. Recite: "Major Illness Insurance medication review, may I help you?"

Annie: "Hi, I'm calling to get a seizure medication, Spykenwayv, covered for our patient Amy G'Dala for 2015."

Ms. Recite: "Certainly, let me look at her records... Has she failed the required generic medications?"

Annie: "Yes, same as last year when we went through this."

Ms. Recite: "Okay. I still have to ask, as some of our policies have changed for 2015. How long has she been on Spykenwayv?"

Annie: "Since 2010, same dose as last year.”

Ms. Recite: "And is it still working for her?"

Annie: "Yes. She's been seizure-free since she started it."

Ms. Recite: "Good. Now, for 2015 we have quantity limits of 30 pills per month on all of our tier 4 medications."

Annie: "But Spykenwayv can't be taken only once a day. It has to be twice a day because of its half-life. So she'll need 60 pills, technically 62, since most months are 31 days."

Ms. Recite: "Well, for 2015 Major Illness will only pay for 30 per month. That's the best we can do."

Annie: "Can I talk to..."

Ms. Recite: "Perhaps she could try taking it every other day? Maybe use a cheaper medication for the days between?"

Annie: "Uh, you can't do that with epilepsy medications. You have to maintain a stable blood level because..."

Ms. Recite: "Could she skip it on days when she isn't working? If she has a seizure at home would that be a big deal?"

Annie: "Yes. It would. She could have multiple seizures and end up in ER. She could die. She could injure her kids, or have a car accident."

Ms. Recite: "Since you mentioned ER, please remember that for 2015 Major Illness strongly recommends you go to one of our approved urgent care centers instead. They have convenient locations throughout the greater Grumpyville area and are staffed from 8:00 am to 6:00 pm weekdays and 9:00 am to 4:00 pm Saturdays by trained medically-affiliated professionals."

Annie: "I'd like to talk to a supervisor, please. This is an issue that seriously affects a person's life and well-being, and you're reading to me from a script."

Ms. Recite: "It may take a few days for her to get back to you. We only have one right now, and she's swamped. The other 2 both quit last week."

Workin' on a...

With spring coming and the snow finally receding, Mrs. Grumpy sent me out last night to buy gardening crap so she can try growing tomatoes at home (if this works, it could save us a fortune in tire wear and gas).

At the store I passed this sign:

Does it make anyone else think of the song "Sex Farm" by Spinal Tap?

"Gettin' out my pitchfork."

Neurologists telling neurology jokes

Jake is an elderly widower who lives at Shady Acres Care Home.

One day Sadie, who lives down the hall, comes over. "Jake," she says, "tomorrow the group bus is going over to see that new movie, and I'd like to go. But I haven't been to a movie since my husband died, and I'm nervous about going alone. Will you go as my date?"

Jake thinks for a moment. "You know, I haven't seen a movie since my wife died. I'd like to... But I have a request. Whenever we'd go to movies, I'd unzip, and my wife would hold my winkie during the film. Would you do that for me?"

Sadie thinks about it. "Why not? We're both in our 80's. What have I got to lose?" So they go to the theater, she holds his penis for the whole 90 minutes, and they both have a good time.

This goes on for the next several months, at every Wednesday movie outing.

Then, one day, Sadie calls to make sure they're on for that afternoon's trip, but Jake can't go. "I have a cold, Sadie. Sorry."

And the next time. "Sadie, I have a doctor's appointment."

And the next: "Oh, Sadie. I can't. I have to wash my hair."

"Jake, you don't have hair."

"I mean, the hair on my back."

This continues for another few weeks. Finally, Sadie confronts Jake outside the day room.

Sadie: "Jake, what's really going on? Why aren't you going to the movies with me anymore? No excuses."

Jake: "I... I've been going to them with Irma instead. I didn't know how to tell you without hurting your feelings."

Sadie: "IRMA? In room 507? Why? What does Irma have that I don't?"

Jake: "Parkinson's disease."

SOLD!

Dr. Grumpy: "So, what are you guys up to next?"

Mrs. Discount: "My daughter and I are going to run a few errands, then stop at Schit Haüs for lunch."

Dr. Grumpy: "Didn't you guys go there after your last visit?"

Mrs. Discount: "Yeah, we have lunch there a few times a month."

Dr. Grumpy: "That's funny, my wife and I tried it once, and didn't like it at all."

Mrs. Discount: "Honestly, I don't think it's very good, either, and my daughter can't stand it."

Dr. Grumpy: "Then why do you guys keep going there?"

Mrs. Discount: "She buys their Groupons. She says it's a good deal."

Thursday afternoon whatever

Ms. Chlorophyll: "I have migraines, with photosynthesis."

Dr. Grumpy: "You mean photophobia."

Ms. Chlorophyll: "Whatever."

Rambling

The following voicemail was left on my phone last night.

"Hi, Ibee, It's Rick Radar, on call in radiology tonight. You ordered a CT scan on Mrs. Confused, and it looks okay, no stroke or bleed (pause) okay, next report, chest X-ray on Seymour Phlegm, AP and lateral views, study done for persistent cough. File number 67874. No acute findings. Heart size normal (pause) next is an IVP on Kid Neestone, diagnosis is flank pain. File number 71985. Study done with iodine contrast shows a large renal stone partially obstructing the right ureter (pause) next is a 3 view cervical spine series done for neck pain. File number 37495. Normal alignment of neck vertebrae, no fractures or other abnormalities (pause) next...

He ran out the full 4 minutes of time, too. You just know he's going to be down in transcription today, wanting to know how they lost last night's dictations.

Seen in a chart

Recently I picked up a fellow who had a serious accident a few years back, and was thrown from his car. He landed on his head, and required emergency neurosurgery and a LONG course of rehab.

So, as usual, I got a copy of his previous neurologist's records. In one of the notes was this comment:

Reverse polarity

Dr. Grumpy: "Do you have any major illnesses?"

Mr. Negative: "No, just diabetes and high blood pressure."

Dr. Grumpy: "Do you take any medications."

Mr. Negative: "No, only Coumadin, Insulin, and Lisinopril."

Dr. Grumpy: "Are you allergic to any medications?"

Mr. Negative: "No, just Iodine and Penicillin."

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

Mr. Negative: "Yes, they're all healthy."

Holiday Road

Last week, there was a mention over on Cartoon Guide to Becoming a Doctor about never telling patients that you're on vacation, always say you're at a conference. While it wasn't the main point of the post, it caught my eye.

I know a lot of doctors who do that. Hell, I think my Dad (a lawyer) used to do it, too.

But me? No. If I take a vacation, I have no issue with patients knowing. If they don't like it, or get upset when I'm out sick, they can eat rocks. Or, better yet, find another neurologist, one who (as Annie puts it) "can provide for your very special needs better than we can."

Here's my weekday schedule: Alarm goes off at 4:00 a.m., so I can begin hospital rounds and see new consults that came in overnight. I get to the office between 6 and 7 so I can review stuff that came in overnight, look at charts for people coming in that day, and finish up any dictations from the day before.

Starting at 8, I see patients straight through, finishing up around 5:00 p.m. Unless there's a drug rep bringing lunch I usually have a noon patient, too. Crammed into the gaps I'm reviewing test results, returning calls, dictating notes, and exchanging insults with Pissy and the staff.

Then I have another 1-2 hours of hospital stuff to go back for. EEG's to read, test results to check, patients to send home, new consults to see. Then I get to head home. So, by the end of an average week, I've logged 60-70 hours.

Weekends? If I'm not on call, it's relatively quiet. That's good, because I need the time to catch up on all the crap that got tossed on my home desk during the week I didn't get a chance to look at. But if I'm on call (once every 4 weekends) I'm pretty much stuck at the hospital. I'm required to be able to be there within 30 minutes if called urgently. Since I live about that far away, it's easier to just stay there and deal with the pile of consults as they come in, rather then try to return home to do anything but sleep.

I'm not looking for sympathy. I signed up for this. I'm not bragging, either. This is what I do. I have a family, staff, and patients who depend on me.

But after living like that, week in and week out, I never feel guilty about taking time off. Besides, I don't actually go to conferences. With my schedule the last thing I want to do with my free time is use it to hang out with other doctors.

I work pretty hard. Like most of my patients, I have a family and a life outside of my work. And if they don't like that, or have a need to think that I live for this shit 24/7, then they're welcome to find a doc who does. It isn't me.

Overheard in ER

Ms. Viridae: "I want to get checked out, you know, down there, because my roommate has herpes, type 2, and I'm afraid I caught it from her. We were sharing the same fork."

Dr. ER: "Uh, what exactly were you doing with the fork?"

Skool Nerse Time

This is Mrs. Grumpy.

Due to the number of cases of head lice that crop up over the course of the school year, I'd like to make some recommendations based on my experiences.

1. There are several reputable products that remove lice. Gasoline, wood varnish, and Draino are not among them. While I'm sure Draino did get rid of them, you now have a meeting with a state agency.

2. Chiropractic manipulation will not make the lice go away, regardless of what Dr. Cracker may have told you.

3. Rubbing garlic on your child's head will not harm the lice, though it may protect them from vampires, werewolves, and pretty much anything with a nose.

4. Having your kid drink Red Bull, hoping she'll run around more and make the lice fall off, will not get you anything but sleep-deprived. And I will call you to come take your moth home until she reverts to a child.

5. Bringing kids to my office and demanding I "do something" will only get you a list of products. I don't carry them here. The district doesn't even cover bandages, FFS (yes, I have to buy those myself, thanks, Governor). I don't have a magic wand.

6. Local Pharmacy is not going to give you lice-removal products for free. Saying your kid caught them at a public school, their store, or on a school bus will not change that. Neither will asking them to call me to try and bill the school district for them.

7. Screaming, yelling, and blaming the school, the teachers, other parents, other kids, "those Arab people near the bus stop," the President, and society in general will not change the fact that your precious has lice, and you have to deal with it. In spite of this, I'd have to say it appears to be the most common method of dealing with the situation.

8. Threatening to scare lice off by shooting firearms near junior will only result in me calling the state. And the lice won't care.

9. If you choose to shave them bald, the school is not responsible for other kids making fun of them.

10. Calling your pediatrician for Amoxicillin will not help. They may laugh at you.

This has been a public service announcement.

For an even better PSA involving lice, read this, by the Skeptical OB.

Modern medicine

The horseshit chart systems that most hospitals use these days are full of crap that's automatically stuffed in there, no matter how irrelevant it is to the case.

Last night I received a hospital consult on a 92 year-old man with severe, end-stage Alzheimer's disease. He'd been found unresponsive (at least, more unresponsive then usual) in his wheelchair at a nursing home (where he's lived since 2009), and was subsequently found to have a huge stroke.

Of course, the computer chart program inserts this paragraph IN EVERY DOCTOR'S NOTE on him (including my neurology consult), regardless of whether we actually want it in there. Because, it's what the hospital admin people say is important for good patient care. And who knows more about good medical care than an administrator with a business degree?

Memories...

Back in my residency, MRI's were printed on this stuff called "film" that would be hung on a reading board. Like most neurology programs, we did MRI's pretty much around the clock, and so there were a lot of films to be read and reviewed on any given day.

Each day, around 1:00, the residents and attending physicians would all cram into a small room with the neuroradiologists to review that day's studies, then make decisions on what the next step was for each case.

One of the other residents, Paul, began having migraines during training. Like most young doclings, he was convinced something was horribly wrong (migraines are actually common among neurologists).

So he conned one of the radiology techs into doing a brain MRI. Like all the other scans, it got hung up on the reading board to be reviewed for the 1:00 meeting.

While my team went to get lunch before the MRI session, I ran to the pediatric neurology clinic across the street. I dug through their film room, trying to find the most horrifyingly abnormal, congenitally malformed, brain MRI study I could. Then I hurried back over and switched it out with Paul's films.

He screamed when it first came up. After about 10 seconds he hit me with a clipboard and said "There's a special place in hell for you, Ibee."

Quote du jour

Dr. Grumpy: "Are you allergic to any medications?"

Mr. Fleming: "I can only take penicillin to use as an antibiotic. If I take it for any other reason I get a rash."

Bartender, make that a double

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

Mrs. Chromatic: "I need refills on my Skizadrine."

Annie: "Okay... Actually it looks like the doctor gave you a year's worth of refills just last month."

Mrs. Chromatic: "It doesn't say that anywhere."

Annie: "It should be right on the bottle."

Mrs. Chromatic: "Oh, I put the medication in an old bottle from another store."

Pause

Annie: "Why?"

Mrs. Chromatic: "I like the color better."

Today's quiz

These people are:

A. The way people usually look when told they need to see me.

B. Americans watching soccer.

C. Waiting for cronuts.

D. Iowans preparing for the 2016 election cycle.

E. KISS without their make-up.

F. The Village People - 2015.

G: Uber drivers.

H: Taxidermied.

I: Folks you can meet with Tinder.

J: All currently in my waiting room, and sick of reading People.

K. In a drug company ad for a stimulant.


- Thank you, Brick Man!

Crunch time

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

Mr. Scrum: "I'm having memory problems that keep getting worse. I'm concerned they're related to all my head injuries."

Dr. Grumpy: "How many head injuries have you had?"

Mr. Scrum (pulls out paper): "Uh, 24 in the last 15 years, where I've lost consciousness, and a few more where I've only seen stars. My memory seems to get worse with each one."

Dr. Grumpy: "That's a lot of head injuries. How did you get them?"

Mr. Scrum: "I play rugby every weekend. What can I do to stop having head injuries?"

Dr. Grumpy: "Have you considered quitting rugby?"

Mr. Scrum: "Do you think that would help?"

Monday morning call check-out

Dr. Grumpy: "Then, in room 834, is a 71 year old lady who came in yesterday with left-sided weakness. I put her on Strokebegone and ordered an MRI..."

Dr. Nerve: "What did the MRI show?"

Dr. Grumpy: "Don't know. It was scheduled for late last night. You'll have to check it."

Dr. Nerve: "I did. It showed her old strokes, but nothing new. It was dictated at 2:18 a.m. this morning."

Dr. Grumpy: "Then why the fuck did you ask me what it showed?"

Dr. Nerve: "I wanted to see if you were following the patients."

Dr. Grumpy: "I am, but I'm not getting up in the middle of the night and logging in to see if results are up. The radiologist pages me if it's urgent."

Dr. Nerve: "You should be more thorough."

Translations

These were the lenses I got Frank. I love the back of the box:

Valentine's Day

My wife and I are beyond the stage of trying to do something pricey for Valentine's Day, and figured we'd just grab dinner at a small Italian place that's under the radar. Of course, even that didn't happen. As we got ready to go out last Saturday, we realized Frank's coughing and hacking was starting to look like strep throat. So much for dinner.

Since it was Saturday night I took him over to Local Hospital's urgent care. Yep, his throat looked bad. Yep, the rapid screen was positive. The doctor called in Streptokill, and I stopped at 24-Hour Pharmacy to pick it up. Frank stayed in the car to post Instagram photos of his gross-looking pharynx (in retrospect buying him that zoom lens set wasn't a great idea).

The pharmacy is one of the generic box ones you see on every street corner in America. And, I have to say, it's probably the most depressing place in the world to be at 8:45 p.m. on Valentine's day.

In my brief time there I watched as bored employees marked down chocolates to get rid of them (they probably knew my Mom was coming in the morning). A guy ran in, frantically grabbed whatever teddy bear was left in a display, threw money at the cashier, and headed out again.

Another glanced over the few residual sad-looking roses, pulled out the one with the most remaining petals, checked out, and started to leave. In a sudden burst of optimism, he turned around and walked back to get condoms, too.

The pregnant cashier (who'd just returned from her smoking break) was mumbling on her cell phone "he's such an asshole. I'm fucking working tonight so he can stay home and watch TV. No, maybe tomorrow. I have to pick something up at McGrease for him to eat when I get home."

The pharmacist and I knew each other from multiple shared patients, and her area was quiet at the moment. We chatted for a few minutes as she filled Frank's script, commiserating about junkies, crazies, and other denizens of our lives. Then she said she had to get ready for post-Valentine's morning, and went to make sure she had enough Flagyl and Plan B in stock.

On the way out I watched a few more desperate-looking guys run in to buy marked-down chocolates and cards. And, with perfect timing, the generic 80's overhead pop soundtrack played the J. Geils Band's "Love Stinks."

When I got back to the car, Frank had barfed in the back seat.

Sandbox

Every few years my hospital requires its staff, including doctors, to take "sensitivity training." This is to make us learn from a 20-minute computer-generated quiz anything that we didn't learn while growing up.

So, to show you how valuable this is, I thought I'd post examples of the questions we get:

The rest of the questions are similarly obvious shit, to ensure no one fails. But, in case you do, you're allowed to re-take it as many times as needed. This way, if someone snaps and assaults a co-worker, the hospital can say "Hey, it's not our fault, they passed a test."

And people wonder why health care costs are so high. This (and 7 figure CEO bonuses) are some of the crap that your insurance premiums are going towards.

So there you go, people. This is how your nurses and doctors learn to behave. I hope you feel more confident in us now.

Theater

This message was left on Annie's voicemail yesterday during lunch.


"Hello, this is Michael from CareLess Insurance, calling about an MRI request we received on William Gilbert. We've authorized the MRI. The reimbursement code is 4Q2, and it's good for 60 days. Thank you. What were you saying? Is that an evil eye, or are you coming on to me again? That's priceless, maybe I should get it tattooed on my ass. Really? I can get that, tattooed, too. Imagine the look your dad would give me at the pool. Are you serious? Well, I mean, I'd have to see what it costs. Does he even know what we're up to? Oh, shit. I forgot to..."

Click.

Skool Nerse Time

This is Mrs. Grumpy.

I think these newfangled SMART Boards the school has are great. So much neater and easier then the black boards and clouds from screeching chalk when I was a kid. It's nice for a teacher to be able to work on something at the computer and have it right up in front of the class as she talks. It's also great that there's a free app to let them control the board with their iPhone (provided the Bluetooth works properly).

But obviously, these have their limitations, as Ms. Steele and her social studies class learned last week.

Apparently, while the kids were supposed to be working on papers, an enterprising young fellow named Albert used the app on his iPhone to take control of the class board. It was turned off, but he switched it on.

As we all know now, the default setting is to show whatever happens to be on the teacher's desktop screen. Normally, this wouldn't have been a big deal, except Ms. Steele was actively exchanging steamy emails with her boyfriend about their Valentine's Day plans.

Her class was controlled enough to not break out giggling when this started, leading other students to join in the fun. Specifically Nathan, who saw she was using her official school email account.

So he used his phone to google up some pictures of couples in compromising BDSM activities and sent them to her, resulting in them showing up on the SMART Board within a few seconds.

When Ms. Steele gasped (you'd think she'd never seen such things before), then realized what was happening on the screen behind her, she was obviously shocked. She jumped up and started to yell, but apparently stopped when she hit her head on the shelf behind her. Then fell back onto the desk. Which is how I ended up involved.

Ms. Steele required 7 stitches at local ER. From her emails, it wouldn't surprise me if she was back there over the weekend for other issues.

Nathan and Albert have each been suspended for a few days.

A district memo was sent out asking teachers to not use their work emails to plan "50 Shades of Buck Naked" escapades. More importantly, it STRONGLY reminded staff not to use the default "1111" password for SMART Board Bluetooth remotes.

I think there's a lesson somewhere in all of that for each of us.

Random pictures

Okay, time to hit the mailbag for some pics you guys have sent in.


First, there's this great letter which somehow brings together those 2 sadly inevitable parts of life: death and (even more frightening) having to go to Walmart:

Next is this great memory from World War I, or World War II, or some war, somewhere

"Do pick-ups include my Chevy truck?"

Here we have a coat hanger, featuring an important safety tip:

Next is an Amazon ad for a tri-wing screwdriver to repair Nintendos. Though, from the picture, only the "screw" part is accurate.

"Well, it does say 'hand tools'.

And... I guess we're done.

Happy now?

A few weeks ago, the paper towel dispenser in the doctors' lounge bathroom broke.

Now, we're not talking broke as in "crank came off and they put extra towels on top to use." I mean broke as in "fell off the fucking wall and shattered, leaving a gaping hole in the drywall" broke.

How this happened, I have no idea. The general consensus is that a surgeon was somehow involved.

Anyway, I digress.

So, naturally, several of us complained about it to maintenance (drying our hands on our shirts seems unsanitary). After 2 weeks of us pissing and moaning, one of them finally promised it would be repaired this week.

So, yesterday morning, this is what greeted us:

Thanks, guys.

Once, twice, three times a lady

Dr. Grumpy: "Are you taking the new medication on schedule?"

Mrs. Bidtid: "Yes, three times a day, just like the bottle says."

Dr. Grumpy: "How far apart are you spacing them?"

Mrs. Bidtid: "Every 12 hours."

Real Genius

Like many other iPhone owners, Mrs. Grumpy has been having Bluetooth problems since the introduction of iOS 8. I personally haven't been affected by this, because my car is so old that its highest tech feature is an AM radio (I passed on the 8-track option).

Anyway, due to this driving her nuts, I tested it with my phone and couldn't get it to work either.

So I made an appointment and took both phones to the Apple Genius Bar this weekend (I'd like to have taken the car, too, but driving through the Grumpyville Mall is frowned upon). There I waited patiently with other pissed-off iPhone users and listened to the soothing sound of Journey's Greatest Hits being played overhead.

The "Genius" there (who wasn't able to help, BTW, Tim) decided to make sure my phone's Bluetooth connection worked. So he said "do you have any music on this?" When I said "yes" he turned on my music app (which is set for random shuffle) and went to get a Bluetooth speaker. He set it down next to my phone, called up my Bluetooth menu, and looked over the list that appeared. Mumbling "I think the speaker is this one" he tapped a selection.

To his horror, he'd actually just linked my phone to the store's overhead speaker system. Suddenly Journey's "Any Way You Want It" stopped, to be replaced by a random selection from my iTunes...

Which was "The Internet is for Porn" from Avenue Q.

He hurriedly turned it off and muttered "It looks like your Bluetooth is working."

Let it go, let it go...

Seen in the Costco catalog. Really.

"Wait'll you see our ads for the new Tampax™ Icicles."

Althought, admittedly, there have been stranger product marketing tie-ins.

Patient quote of the day

"I know this seizure wasn't as bad as others, because I was able to post about it on Face Book."

February 5, 1938

Hans Litten

A German man died on this day in 1938. A very good one.

His name was Hans Litten. His father was a lawyer, and was a decorated WWI veteran.

Hans grew up in the difficult years of WWI and postwar Germany. Although his family was wealthy, from the start he had great sympathy for the less fortunate. In an episode that greatly upset his father, Hans took food from their kitchen to give to a beggar... and addressed the beggar as "sir." As he grew older he became increasingly involved in issues affecting workers and the disenfranchised.

Although he wanted to study art history, his father pressured him to become a lawyer. While reluctant, Hans threw himself into his studies and quickly moved to the top of his class. Upon graduation he was offered 2 good jobs, one with the German Ministry of Justice, the other with a renowned law firm. He declined both, going into private practice with a friend.

In the late 1920's he was alarmed by the increasingly nationalistic tide in Germany, seeing right-wing thugs get away with increasing violence against Jews, immigrants, and manual laborers. He took cases representing those who'd been attacked or discriminated against, and was successful.

He worked closely with charitable organizations that supported the needs of ordinary workers in the difficult post-war year, providing them financial and legal assistance.

As a person, he was brilliant. He spoke fluent German, English, Italian, Hebrew, and Sanskrit, and had a tremendous knowledge of art, classical music, and poetry. He particularly enjoyed music, spending many evenings at the symphony.

In 1929 a traditional May Day rally in Berlin turned violent, with the police firing randomly into the crowd (killing 33) and beating many more with truncheons. Several workers were charged with inciting the demonstrations, and Litten defended them. He took many similar cases, trying to bring to light the increasingly heavy-handed tactics of the German government.

On the night of November 22, 1930, a small paramilitary group, secretly working for the nascent Nazi party, attacked the Tanzpalast Eden, a dance hall that was popular with immigrants. They killed 3 and injured 20... and the subsequent police investigation was intentionally slow and fruitless.

Litten accepted the case on behalf of 4 injured plaintiffs, trying to secure criminal convictions against the attackers and show that the attack was intended to further destabilize German society in favor of the Nazis. Although their later history is well known, at this point the Nazi party was publicly distancing themselves from their secret armed squads in order to appeal to moderate Germans.

And, to help his case, Litten had the court summon Adolf Hitler to the stand.

In what (in retrospect) must have been a truly remarkable day, Litten aggressively cross-examined Hitler for 3 hours, forcing him into several contradictions. Under oath, Hitler defended the brown shirts as being devoted to non-violent "intellectual enlightenment." It also included this exchange:

Litten: You said that there will be no violent acts on the part of the National Socialist Party. Didn't Goebbels create the slogan, "one must pound the adversary to a pulp?"

Hitler: This is to be understood as "one must dispatch and destroy opposing organizations".

Litten Since you've named Goebbels as Reich Minister of Propaganda, are you aware of the passage from his book where he declares that fear of the coup d'état cannot be permitted, that parliament should be blown up and the government hunted to hell, and where the call to revolution was made again?

Hitler: I can no longer testify under oath, if I knew Goebbels' book at the time. The theme is absolutely of no account to the Party, as the book doesn't bear the Party emblem and is also not officially sanctioned by my Party

Later.....

Litten: Is it correct that Goebbels' revolutionary journal, The Commitment to Illegality, has now been taken over by the Party and has reached a circulation of 120,000? The journal is sanctioned by the Party.

Presiding judge: Herr Hitler, in point of fact, you testified this morning, that Goebbels' work is not official Party material.

Hitler: And it isn't, either. A publication is an official Party organ only when it bears the emblem of the Party.

Litten: Then, how is it possible that the Party publishing house takes over a journal that stands in stark contrast to the Party line?

Hitler (shouting, red-faced): How dare you say, Herr Attorney, that is an invitation to illegality? That is a statement without proof!


Hitler was badly rattled when he left the stand, and forbid others from ever saying "Litten" in his presence again. When the name was mentioned he became irate. He was subsequently investigated for perjury, though managed to evade charges.

As Hitler rose to power, it was obvious that Litten's time was running out. Family and friends told him to flee Germany, but he refused because clients still needed him. On the night of February 28, 1933 he was arrested at his apartment, and would never be seen in public again.

Over the next 5 years he was moved from prison to prison and repeatedly beaten and tortured. He lost the sight in one eye and hearing in one ear. Most of his teeth were knocked out, and one leg was broken so many times it became useless. His jaw was broken in multiple places. Often he was so battered that fellow prisoners weren't allowed to see him.

In 1935, during a rare interaction with other inmates, he recited one of his favorite childhood songs, "Thoughts are Free." Their guards failed to realize the significance of the words.

In 1937, although baptized and raised as a Christian, Litten was classified as Jewish on the grounds that his paternal grandparents were Jews. He was moved to Dachau concentration camp, where, on the early morning of February 5, 1938, he hung himself in the bathroom.

He was 35 years old.

Forces of nature

Mrs. Frost: "A lot of this is just the weather... my migraines always get worse in winter. I wish I had the money to travel. Is there anything else that can be done for them?"

Dr. Grumpy: "Well, I could try adding a medication when the season starts to change that..."

Mrs. Frost: "No, I mean, something that I could do about keeping the weather more stable. Can I take a doctor's note to a government weather department or something?"

Mary's Desk

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

Ms. Chatter: "I need to see Dr. Grumpy. My last neurologist moved away, and I'm trying to get my records from them so that (ramble, ramble, ramble)."

Mary: "Okay, let me see... We have an opening next Tuesday, at 3:45."

Ms. Chatter: "That won't work for me because Tuesday afternoon is when I watch my grandkids because my daughter works and her boss is an asshole because (ramble, ramble, ramble)."

Mary: "All right, what about... How's Thursday morning, at 8:00?"

Ms. Chatter: "Perfect. Mornings are always good for me because my husband walks over to the city pool to swim laps at the indoor one and I can have the car. They just opened the pool again last month, it was closed for almost a year, because I guess it had fallen behind all these state health codes and they had to set aside money to do the project, and (ramble, ramble, ramble)."

Mary: "Okay, I have that down. What insurance do you have?"

Ms. Chatter: "I'm with Sickness & Wealth HMO."

Mary: "Oh... I'm sorry. We aren't contracted with S&W."

Ms. Chatter: "WHAT? WHY DIDN'T YOU TELL ME THAT IN THE FIRST PLACE? YOU'RE WASTING MY TIME!"

(click)

Cough drops

Last week I was sick (I'm fine now, thanks). It was just another nameless viral crud that my pet fomites kids brought home from school.

Anyway, to get through work (I'm in solo practice, where we aren't allowed to take sick days. Only dead days are acceptable) I invited over my usual friends: Sudafed, Tylenol, Dextromethorphan, Guaifenesin, and Halls. When I'm sick, this gang and I know how to party.

To my horror, my old friend Halls has apparently been put on Prozac. In a bizarre move taken from fortune cookies, the company decided that infectious diseases should be made even more miserable by putting happy inspirational ditties on the wrapping.

So, this is where we are. It's no longer good enough to make a decent product for the snotty & hacking, but to provide ersatz emotional support with "a pep talk in every drop." Better yet, they even trademarked that statement.

Not that the comments help, either. When I'm sick my "game face" looks more like a death mask, and my "battle cry" has pulmonologists drooling. And I sure as hell wouldn't bet on myself.

Here's some others:

The last one I find particularly odd. "Hi-five yourself" sounds like a euphemism for, well, other things besides illness that require Kleenex.

Celebrity fail

Dr. Grumpy: "The neck MRI didn't show anything serious, so he should be okay:"

Dr. Hospital: "Good. He had a bad fall, and I was worried he'd be paralyzed. You know, like the Superman guy Steve Reeves."

"Or was it Keanu, or Dan, or Martha... maybe there isn't an 'S'..."