Patients from the future

Local nursing home sent this paperwork over today with a patient.

Their math sucks, regardless of how you look at it.

Just Shoot Me

Mrs. Handz: "I think I have Carpal Tunnel Syndrome. My hands and fingers go numb when I'm typing."

Dr. Grumpy: "What about when you're holding the steering wheel, while driving?"

Mrs. Handz: "Yeah, then too, and OH MY GOD! YOU'RE GOING TO TAKE MY LICENSE AWAY!"

Dr. Grumpy: "No, not at all! I'm just trying to get an idea of what triggers the symptoms."

Mrs.Handz: "I don't believe you! My friends warned me this might happen! You're going to turn me into the MVD and stop my driving!"

Dr. Grumpy: "I'm honestly not. I ask because Carpal Tunnel Syndrome can..."

Mrs. Handz: "I'm leaving before you ask more questions! I know your game!"

(patient storms out of the office)

Thursday afternoon

Mrs. Daughter: "Thank you for seeing Mom today. She's blind, and hard of hearing, so getting through to her can be difficult."

Dr. Grumpy: "How do you communicate with her?"

Mrs. Daughter: "She speaks Braille."

Neurologists- the original party animals

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

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

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

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

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

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

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

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

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

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

Attention staff!

This morning I dragged in early because I couldn't sleep. To keep it quiet at home I decided to brush my teeth and shave at the office. I keep stuff here for the occasional times this happens.

You guys know that I'm usually half asleep when I come in on these days.

If I figure out which of you filled my little toothpaste tube with K-Y jelly while I was gone, you're fired.

Mary's Desk, August 10, 2010

Man comes in, signs in, stands at counter. Mary looks at his name and checks the schedule.

Mary: "Sir, we don't have you listed for an appointment. In fact, it doesn't look like you've ever seen Dr. Grumpy."

Mr. Lost: "You're wrong! I have an appointment right now!" (whips out appointment card, hands to Mary).

Mary: "Um, your appointment is with Dr. Darth, the neurologist across the street. You're at the wrong doctor's office."

Mr. Lost: "So you people screwed up my appointment? Dammit!"

Mary: "Sir, your appointment isn't at this office. I'll call over to Dr. Darth's and let them know you're on your way. Do you know how to get there?"

Mr. Lost: "Of course I do! Where is it, anyway?"

Mary: "You go back to the street and make a left turn, go 1 block down, make a right, and it's the 3rd building on the left. Here's the address."

Mr. Lost: "I don't want to pay a co-pay, since this is you people's fault."

Mary: "Well, you can discuss that with his staff when you get there. I'll call now and tell them you're coming."

Mr. Lost: "My car is low on gas. Can you drive me to his office?"

Smells like left brain

A key epilepsy question (at least to a neurologist) is "Where in the brain is the seizure coming from?"

As a result of this, we neuro docs look for clues as to which side of the brain is the seizure trigger, so to speak (we call it "lateralization"). Sometimes the answer is obvious on MRI or EEG, sometimes it's more subtle. In those cases we have to look for details in the patient's history or exam that lead us to the answer. Different findings have what we call "lateralizing value", meaning how useful it is.

Now, I'm all for further research into this. But, I have to say, some researchers looking for new lateralizing features have gone a bit too far. Or at least shown a determination to notice things that I don't want to.

(Neurology word: "Ictal" means "seizure-related")

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I'd like to thank the Science Marches On Department for bringing this important research to my attention.

Patient quote of the day

"Doc, you should have seen the way the blood was pouring out of my nose. It was, like, like, um, like really horrible diarrhea. Except it was red. And it was coming out of my nose."

Come on over, Mom, we're having a party!

I was doing some medical education credits online this morning, and came across this question. I just LOVE the 4th answer.


(click to enlarge)

Date night

Waitress: "Hi! I'm Lacey! I'll be taking care of you tonight. How are you folks doing?"

Mrs. Grumpy: "We're fine. How about yourself?"

Waitress: "So-so. My daughter spent most of the afternoon in ER!" (starts crying).

Mrs. Grumpy: "Oh... I'm sorry. Is she okay?"

Waitress: "She shoved a Lego up her nose!"

Dr. Grumpy: "Usually they can get those out."

Waitress: "The doctor there tried for, like 2, hours, and couldn't. So on Monday we have to take her to a pediatric ENT."

Mrs. Grumpy: "I'm sure she'll be okay."

Waitress: "Our specials tonight are meatballs fornicato..."

Memories...

It was the early 80's, and Big State University was under a reign of terror (okay, more of a reign of creepiness) about an evil criminal mastermind.

I don't remember his name, if I ever knew it at all. One of my co-workers dubbed him "The Mad Whacker". It was as good a title as any.

He had a fetish for buildings. Really. He was sighted in front of various places on and around campus, staring at buildings, and, uh, madly whacking.

But he had a preference for religious places. The Mormon center. The Campus Crusade for Christ office. The Jewish Hillel center. He didn't discriminate. He'd stand in front of them at night, and, if he didn't see anyone immediately around him, do his thing.

Enter into the picture young BSU student Ibee Grumpy.

He was thinking about becoming a doctor someday, so was looking for anything to pad his resumé. More importantly, he was interested in meeting girls. Or at least trying to figure out how to talk to one without barfing from anxiety.

So he joined the campus safety patrol. This group of dedicated (and similarly lonely, resumé padding geeks) carried radios and were tasked with walking girls to different locations around campus at night to help deter crime.

So one night, Student Grumpy was on his way back from walking a girl out to her car, and took a shortcut near the Catholic center.

And there he was.

I don't remember who was working dispatch that night. I think it was a guy named Rob. I picked up my radio, trying not to be too loud.

"Come in, Rob"

(for those of you who remember the scene in Ghostbusters, I felt like Bill Murray, mumbling into the radio "Come in, Ray. It's looking right at me, Ray." And like Bill Murray's character, I was hoping not to get slimed).

Rob: "Dispatch, what's up?"

Student Grumpy: "It's the Mad Whacker, Rob . He's in front of the Catholic Newman Center."

Rob: "Are you shitting me?"

Student Grumpy: "No! Why don't you call someone to come get him? I've only got a radio with me."

Rob: "Okay. Is he almost done?"

Student Grumpy: "How the fuck should I know? You want me to ask him?"

Rob: "Tell him to drop it and put his hands up."

Student Grumpy: "Will you send somebody?"

Rob: "I did, a campus cop is near you and is running over."

At this point the Mad Whacker heard us, and started to run away. Fortunately, the campus cop was already there, and the Whacker couldn't run very fast with his pants around his ankles.

I have no idea where Rob is today.

I never did date any of the girls I met working there, but you all know what happened to Student Grumpy.

I don't know what happened to the Whacker. He's probably teaching kindergarten somewhere today.

Annie's desk, August 6, 2010

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

Ms. Daughter: "Hi, my Dad has Parkinson's disease, and I was wondering if you had any birthday gift ideas specifically for Parkinson's patients?"

Annie: "Hmm. Well, there's a really good physical therapy program for them over at Local Rehab."

Ms. Daughter: "No, I'd have to drive him to that, and don't have the time. He already has a cane, otherwise I'd get him one. Can you write a script under my name for his meds? That way I can have my insurance pay for them, and save him money?"

Annie: "No, we really can't do that. What about just a regular gift? Like baseball tickets, or a book?"

Ms. Daughter: "No... He likes movies. Do you know of any movies that are out now about Parkinson's disease? He's already seen 'Awakenings'."

Annie: "Why don't you take him out for a nice brunch, or dinner?"

Ms. Daughter: "You people aren't any help at all." (click)

A noiseless flash...

65 years ago today.

My copy is 118 pages, of regular size print. You can read it in an afternoon.

It's just a story about 6 people, all ordinary people, and strangers to each other.

It's just a collection of interviews, first published by "The New Yorker" magazine in 1946, and later put together as a book.

It's never, to my knowledge, gone entirely out of print. You can buy it, used and new, on Amazon for a few bucks (no, I'm not selling my copy. It's a 1946 original, and I stumbled across it in 1996 for $12.85 at a used book store).

It's called, simply, "Hiroshima", and it was written by John Hersey.

It has no science in it. No history of the development of the bomb. No history of World War II (aside from the immediate content). No political commentary on the right or wrong of war. Minimal, if any, emotion. If anything, it's rather dry and simply factual about what the people interviewed said.

It's the collected experiences of 6 people, who at 8:15 a.m. were all 1/2 to 2 miles from the center of the Hiroshima nuclear bomb explosion, and their experiences in the minutes to a few days after.

None of them (like most of us) were politicians. They were:

A Catholic priest
A clerical worker
An internist
A Methodist minister
A widowed seamstress with young children
and a surgeon.

4 men, 2 women.

If you haven't read it, I'm telling you to invest a few bucks and an afternoon in it. It's as powerful today as it was then.

What does she know? She's just the patient

From another neurologist's note:

"Impression: Patient referred here for carpal tunnel syndrome. She clearly has significant headaches, though denies having headaches at all. She also obviously has trouble sleeping, though tells me she sleeps fine. She keeps asking me to address her carpal tunnel syndrome, but that's not the main issue here."



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