Patient quote of the day

"Doctor, I really want to know if I have something. Because if it's anything, it would probably be something. And I want to know if it's something. If it's nothing, then that's not anything, but I need to know if it's anything like something or nothing."

Jerry Springer meets Dr. Grumpy

Sermo is one of many online medical communities. I tried it a few years back, but deleted my membership out of boredom. I'd never written any posts, and got tired of the daily emails on such controversial topics as "doctors should provide patient care," "we all want to make more money," and "hospitals are for sick people."

Anyway, apparently they've livened things up (or it was online sweeps week) because my reader Sally sent in this headline, which was a "Sermo Pick" last week (on Valentine's Day, no less):

(click to enlarge)





This was, actually, a tragic story. A married doctor (Hyo Shin, age 64) had been having an 18-month affair with Sarah Garibay (age 29) a lady he met at a strip bar, and became her "sugar daddy". He died after her other sugar daddy (Jeff Clay, age 49) walked in on them at an inopportune time and beat Dr. Shin. The doctor then jumped out a window to escape, and eventually died from his injuries. Clay has been sentenced to 12 years for voluntary manslaughter.

In a surprising twist, the late Dr. Shin's wife told the court that her husband had "a high moral standard and would not stand for one speck of immorality."

The wife of the convicted Mr. Clay testified that he was "hard-working and non-violent", and that she still wanted him to come back to her even though he'd been seeing 2 other women and using methamphetamine.

Another story noted that Miss Garibay (who denied being a prostitute) testified in court while "wearing a short skirt and low-cut top." She said she "immensely" loved her married boyfriend Clay, and was "hurt" that he subsequently tried to hire a prison inmate to kill her, too.

Anyway, I asked some of my colleagues about their takes on this story, and they had a few pointers:

1. Don't date people you meet at a strip bar.

2. If you do, let the buyer beware.

3. At 64 you should know better.

4. Avoid sugar daddies on meth.

5. There are worse obituaries to have, but not many.

6. Isn't there anything better to do in Yuba City?

Nice haircut, though

Look: Even if you're in a wheelchair, that doesn't give you a license to be a crook.

And if you're going to rob a convenience store, at least have a decent getaway plan.

Thank you, Don!

We have a winner!

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

Mr. Florida: "Yeah, I'm a patient of Dr. Cortex, and I left my medicine back in Grumpyville. I'm visiting family in Orlando."

Dr. Grumpy: "Okay, do you have a pharmacy number there?"

Mr. Florida: "Um, no. Do you recommend any pharmacies near my hotel?"

Dr. Grumpy: "Sir, I have no idea what's there. Why don't you look around the area you're in, or ask someone at the hotel desk?"

Mr. Florida: "Am I allowed to do that?"

Dr. Grumpy: "Yes."

Mr. Florida: "Do you know what medications I'm on?"

Dr. Grumpy: "You mean you don't?"

Mr. Florida: "I told you, I left the bottle at home. I think it was in milligrams. Does that help?"

Dr. Grumpy: "Do you have a way of looking them up?"

Mr. Florida: "Of course. I keep them all on my iPhone."

Dr. Grumpy: "Where is that?"

Mr. Florida: "In my hand. I'm talking on it."

Guest post from Officer Cynical

Today, February 19, 2012, marks the 67th anniversary of the Marines' landing on the island of Iwo Jima. 70,000 U.S. Marines and support troops went ashore against 22,060 entrenched Japanese.

On March 26, 1945, when the island was declared secured, 6,812 Americans (10%) were dead or missing, and an additional 19,217 (27%) had been wounded. Of the defending Japanese force, only 217 were captured. The remaining 21,844 (99%) were killed.

27 Medals of Honor were awarded (13 posthumously) - over one-fourth of all the MOHs awarded to Marines in all of WWII.

I recently had the honor of meeting an Iwo Jima survivor at an assisted living facility. He summed it up this way: "The Japs would not surrender. They wouldn't come out of their caves. So, we burned them out with our flamethrowers, then shot them with our rifles. It was awful".

The picture I've included is not the one you might expect - the flag-raising on Mt. Suribachi. Rather, it is a landing craft of "average" Marines, most in their 20's, throwing themselves into the raging inferno, despite their fears and trepidations. Home must have seemed like a distant planet. We owe them everything.

Sunday reruns

Must be a full moon. Today I had some of the following exchanges with patients:


Dr. Grumpy: "I'd like to see you back in a month".

Ms. X "I'll be here. Unless, of course, the Lord comes before then. He is coming soon, you know."





Dr. Grumpy: "How's your physical therapy been going?"

Ms. Y: "I stopped going because angels have been surrounding my bed at night to heal me."





Dr. Grumpy: "How long have you been seeing Dr. Smith for your heart problem?"

Mr. Demented Psychotic: "Since he raped me in prison".

(for the record, Dr. Smith has never been in prison, nor raped anyone, that I am aware of)

More artisanal crap

Okay, my intense hatred of the overused word "artisanal" (and its derivatives) is pretty well known.

But this one is thoroughly annoying:





Let's look at this:

1. It uses the word "artisan" twice. Once to make you nauseous, and once to make you puke.

2. It's a FREAKIN' JAR OF HONEY PEOPLE! Humans can't even make it.

3. The "Artisan honey keepers" are BEES! I'm pretty sure they aren't making this claim, any more than my dog claims to be an "artisan shitpile keeper."

4. If you're going to put a "gluten free" label on honey, maybe it's time we started putting "fat free" stickers on water.

Trivia answer

Earlier this week I used the term "Hufnagel's Syndrome" in a post.

It wasn't meant to get any sort of attention, I just needed to come up with a disease name.

To my surprise, my stats have since shown a surprising number of people googling "Hufnagel's Syndrome" trying to find out what it was, then being directed back to the post. I've also received about 20 emails asking about it.

So here is the answer: There is no such disease.

The name idea is from a TV show I grew up watching, St. Elsewhere, set in a teaching hospital.

Florence Hufnagel (played by the mostly forgotten, but truly awesome, Florence Halop) was a recurring character. She was the classic patient-from-hell that we all encounter during our training (I didn't realize how accurate her portrayal was until I did my residency 10 years later). She was comically abusive and sarcastic, and made you realize how hard it could be to try and take care of someone you couldn't stand.

Her character made such an impression on a generation of TV watchers (and future doctors) that as recently as 2010 she was being cited in the news as an example.

In one of the most memorable scenes in TV history, Mrs. Hufnagel died from a bizarre combination of cardiac surgery complications and (more importantly) a malfunctioning adjustable hospital bed. It folded up into a V shape, bending her in half and suffocating her. Her death scene showed only one arm, sticking straight out the side of the folded bed.

In a bizarre postscript, it later turned out that she'd left her entire estate to one of the residents (Elliot Axelrod). When he met her lawyer it was (roughly) $50,000, but with taxes, funeral costs, and "an ongoing legal action with American Samoa" it left him with something like $18.73.

So, if you really want to think there's a disorder called "Hufnagel's Syndrome," I suppose it would be being killed by an electric adjustable bed.

Mistaken identity

While he's spending time in Juvenile Detention, I hope this kid gets some botany lessons.

Thank you, Nurse Kitty!

No kidding

This is a drug ad I saw in a journal recently:





What makes it great is the line at the bottom:

Medical research

A number of studies have addressed withdrawal issues, covering alcohol, tobacco, and controlled drugs. A review of the literature, however, shows a surprising lack of research into other addictions. In an attempt to rectify this situation I'm publishing the following data, addressing a transient, yet debilitating, condition.

For the purposes of assessment, and for possible use in future cases, a grading system was developed for this paper. It was based on the World Objective Zeitgeist Joint Organizational Bureaucratic System (WOZJOBS) staging scale data.


Case report:

A middle-aged neurologist recently left his MacBook Pro overnight at the Apple Store for repairs. Over the next several hours he underwent a gradual series of decompensations, which are presented here.

Stage 1: Minor inconvenience. "I can live without my computer for a few hours." Reads paper mail, realizes it's all junk advertising real estate agents, car dealers, and grocery stores.

Stage 2: Needs alternative. Finds things around house which weren't previously noticed: books, magazines, children, pets, spouse. Fingertips begin tingling.

Stage 3: Decides to go online with iPad. Discovers it was left at the office. Considers 1 hour drive through snow back into dangerous downtown area after dark to get it. Finds that spouse let air out of car tires to prevent this. Hyperventilates.

Stage 4: Tries to use iPhone to send long emails and write blog posts, discovers it's not particularly well suited to this. Sprains thumb.

Stage 5: Desperation. Diaphoretic & dyspneic. Dusts off old Windows laptop in the back of closet and is able to get online. It freezes up every 2-3 minutes, reminding him why he stopped using Windows in the first place. Blames Steve Jobs for his current state of despair. Spouse administers sedative consisting of caffeine-free Diet Coke laced with an old Vicodin tablet from the medicine cabinet.

After being sedated the subject was tucked into bed, carefully guarded by a pair of 4-legged orderlies. All symptoms resolved the following day after picking up the repaired computer.


Discussion: Computer withdrawal blows. They should be able to carry out all repairs in less than one-fourth the estimated time (like Mr. Scott) and not have to keep it overnight. Also, caffeine-free Diet Coke sucks.

"Hey, you want to land in jail for Valentine's Day?"

Okay, lovebirds, let's keep this in mind: When getting kinky, remember to keep it private.

Technology

Dr. Grumpy: "How are you doing? I heard you were in the hospital?"

Mr. Bag: "Yeah, I had a bad infection down there. They had to filet my scrotum to clean it out."

Dr. Grumpy: "That sounds awful."

Mr. Bag: (whips out phone) "Here's a picture."

Probably the T-shirt guy

Why is Papa Smurf smiling?