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'..."

Open season

In the last month, 2 doctors have been shot & killed, on the job, here in America.

I'm not going to say medicine is more dangerous than, say, police, fire, or military work. But it's certainly not safe, either. Both of the doctors who were killed were in hospitals at the time. One shot by a disgruntled patient, another by the upset son of a patient.

2 doctors in a month may be only a drop in the bucket in a country where 82 people are murdered with guns every single day, but it still scares the crap out of anyone trying to help patients, not to mention the affects on our families.

Do I get threatened? Yes. Sadly, all doctors and nurses do. People want to feel better. Or be cured of something. Or want more narcotics. Or are unhappy with my telephone system. So they yell and scream, and sometimes threaten. Most of them simply change doctors and a few may post a shitty review of me online. Generally that's as far as it goes.

But that doesn't mean it might end there. All it takes is one person who goes over the edge. And, here in the land of the gun, firearms are easily obtainable by anyone. Even those who hear voices telling them to kill people. Or have a history of violence with a restraining order against them. Or have committed felonies. Even for a doctor, it's hard to tell who is or isn't crazy enough to actually carry through on their threats.

The ER docs and nurses are the front-line in medicine. I don't know anyone who works in ER who hasn't been threatened or struck by a patient. Does that surprise you? Then go hang out in any decent sized ER in America and see what really goes on there. I was a 19 year old volunteer the first time I did that, and on my second shift got punched in the mouth by a junkie while I was taking her blood pressure.

Violence against health care workers is so common it's not reported most of the time. Only the fatalities make the news.

There's no easy answer, either. Put guns on ER staff? A lot of what they do is lean over patients, so it would be pretty easy for one, or a family member, to grab it off their belt. And don't ask about hospital security. Well-intentioned, sure, but at many hospitals the security guards are septuagenarian retirees with pepper spray. You think that's going to deter a delusional schizophrenic with a Glock?

That doesn't mean we aren't armed, too. I know plenty of docs who keep guns in their desks. Not automatic rifles with armor piercing bullets and high capacity magazines, just basic handguns. We all hope to never have to reach for it. That said, it won't do us any good, either, if a distraught and armed patient catches us up front reviewing lab reports. Or talking to a drug rep. Or heading down to our car.

Dr. Pissy has carried a Beretta under his white coat for as long as I can remember. If you don't think your doctor would keep a firearm in his or her office, think again. Like lawyers and university professors, we have our share of the irrationally angry, and we're easily accessible. Those "gun free zone" signs in front of hospitals and schools don't intimidate anyone determined to wreak havoc. And the laws your state might pass making it a felony to assault a healthcare worker aren't going to bother those who are most likely to do so.

For the record, I have plenty of patients who carry guns to the office (including a police officer who accidentally left it on my exam table overnight and I still give him shit about it). It doesn't bother me, either. They're responsible people (except for you, Officer JT) who happen to carry a gun with them and today have a doctor's appointment, as opposed to someone who brings the gun to the doctor's meaning to use it.

Would it protect me and my staff if Pissy and I had obviously displayed sidearms? Maybe... But on the other hand, a key part of medicine is putting the patient at ease, so you can gain their trust and help them. Plenty of people are not going to open up under that circumstance, which defeats the whole point of the visit. Not to mention all the people who let their rugrats run amok in our office and play with whatever they find

Some are going to take this post as saying I'm a gun nut, who thinks everyone should carry a piece. I didn't say that at all.

Others will take it to mean I'm an anti-gun person, who wants them all banned. I didn't say that either.

My point is this: your doctors, nurses, and pharmacists, regardless of where they work, are doing a damn dangerous job. All it takes is one irrational person with an easily-acquired weapon. And there's no easy way to prevent it, either.

Doctors, unfortunately, are easy targets. We're vulnerable, because what we do best - helping others - means that we're also putting our trust in them not to harm us, too. Trust goes both ways. To get you to confide in us, so we can examine you and figure out your problem, means you have to trust us. At the same time we assume that we can trust you in return. This arrangement works out well, tens of thousands of times a day around the world.

But in the last month 2 good doctors did their best to help and trust others. And paid for it with their lives.

Is it covered by Medicare?

Seen in a hospital chart:

 

For my non-medical readers:

QD: Once a day

BID: Twice a day

TID: Three times a day

PRN: As needed

Foresight

Mrs. Newage: "I'm not happy with my current psychic, so I'm changing. She didn't warn me about the car accident."

Dr. Grumpy: "What happened with..."

Mrs. Newage: "One of my friends recommended Char L'tan. But she's booked out for the next 3 months."

Dr. Grumpy: "I had no idea."

Mrs. Newage: "Yeah, the girl there said they didn't realize how busy it would be this year."

Skool Nerse Time

Ms. Ged: "Thank you for calling the CrapCare Insurance pharmacy line. How may I help you?"

Mrs. Grumpy: "Hi, I got a letter saying my son Frank's pills won't be covered starting next month unless I submit an appeal form. It said to call this number to get the form. So I'm calling."

Ms. Ged: "That letter just went out last week."

Mrs. Grumpy: "Yeah, it came in today's mail. That's why I'm calling."

Ms. Ged: "We... don't even have the appeal form ready yet. You weren't supposed to call so soon after getting the letter."

Mrs. Grumpy: "Well, it didn't say that.  It said to call, and I am. When will the form be ready?"

Ms. Ged: "Next month. We weren't expecting anyone to call this quickly."

Mrs. Grumpy: "So the form to continue the medication won't be ready until after we've already run out of medication?"

Ms. Ged: "Yeah. I mean, that's when most of our patients call, anyway."

Love thy neighbor

Uh...

I'm going to assume the confirmatory phone call is also entertaining.



Thank you, Lee!

Loyalty

Mary interrupts me while I'm with a patient. Never a good thing.


Mary: "There's a doctor on the phone, says he needs to talk to you right now."

She hands me a piece of paper. I pick up the phone. It's a guy I've never heard of.

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

Dr. Interruptus: "Hi, this is Cody Interruptus, I work over at the Local Hospital clinic, and I've got a guy here... 27 years old... anyway, he has Flehner-Lathrop Syndrome, and I think he needs to see a neurologist soon, if you could work him in."

Dr. Grumpy: "That's pretty uncommon, and I've never seen a case. Have you called Ivory Tower Neurology? They have a lady who specializes in it."

Dr. Interruptus: "No. I mean, I'm part of the Local Hospital clinic, and would like to keep the patient here, seeing other docs who work out of Local Hospital. In this day and age we all need to work together and support each other in the community. I'd appreciate it if you could help me out. I mean, you can refer him to Ivory Tower afterwards if you need to."

Dr. Grumpy (feeling guilty): Okay... I'll work him in over lunch tomorrow."

Dr. Interruptus: "Thank you."

Dr. Grumpy: "Let me get his info... Looks like Mary wrote most of it down... What insurance does he have?"

Dr. Interruptus: "Sickness & Wealth HMO."

Dr. Grumpy: "Oh... I'm sorry, I'm not contracted with S&W. I never have been. Two of my call partners, Drs. Brain & Nerve, are, let me give you their number..."

Dr. Interruptus: "But this is LOCAL HOSPITAL. Those two work out of OTHER HOSPITAL. You need to help support us and the Local Hospital community. Can't you just see him for free?"

Dr. Grumpy: "He has insurance. This is not a charity issue. I do plenty of charity work for the uninsured. I'm not going to see him for free when there are plenty of docs who take his insurance around."

Dr. Interruptus: "You should be loyal to the hospital. That should be your first priority."

Dr. Grumpy: "I..."

Dr. Interruptus: "Thanks for nothing."

(click)

Mary is FIRED!... again.

Recently, who knows why, the twins have become obsessed with the 1984 Lionel Richie song "Hello."

And by obsessed, I mean singing it to the dogs, to each other, in the car, playing it on their phones, playing it on their band instruments... pretty much UNTIL I WANT TO KILL THEM.

Anyway.

The other day I was bitching about it to Mary, and how damn sick I was of hearing it.

The next morning I was in a room examining a patient, and afterwards walked back to my office. When I sat down to type up some notes, my mouse wouldn't track. It had been working fine earlier.

After a minute I turned it over to see what was wrong, to find this taped to the bottom:

Mary's desk, January 19, 2015

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

Mr. Ecgonine: "I need to get checked out by the doctor right away!"

Mary: "Okay, we have an opening Thursday at..."

Mr. Ecgonine: "No! This is an emergency! I was snorting cocaine this morning, and my eyes started twitching. It must have made me catch cerebral palsy or Down Syndrome or something like that, and I need to get screened for all of those things."

Mary: "Well, I..."

Mr. Ecgonine: "Not only that, but I think I have some sort of cancer. Like lung cancer, or leukemia, or brain cancer, that kind of stuff, and I need to get screened for all of those, too."

Mary: "Okay, but..."

Mr. Ecgonine: "Hey! My dog just peed in the kitchen!"

The line went dead.

Huh?

Seen in a medical market research survey last week:

Weekend reruns

The phones were really ringing today, and so a few calls went to voice mail. Annie had me listen to this one:

"Hi, this is Suzy Frazzled. I'm a social worker involved in the medical case of Kathy Smith. I'm calling to see if you have any records on her. You probably don't, because none of the other doctors on the list she gave me have ever heard of her, either, and I'm on my last damn nerve dealing with her. Anyway, she's blaming every freaking illness she has on a piece of cotton that was left in her ear 2 years ago after she had a glob of wax taken out. Thinks she's won the freaking lottery, apparently. What? No Bob, I don't have that info here. I've been working on Mrs. Smith all damn morning. How come you don't get these cases? The boss gives me all this shit, and it's not fair. Where the hell do these people come from and why do they always end up on my desk? Why can't I get normal cases? Oh, sorry, hello? Anyway, please call me back and let me know if you've ever heard of this lady."

Sigh

Dr. Grumpy: "Which orthopedist did you see?"

Mr. Vague: "He works over on the south side. It was a Dr. Hansen, or Martin. Maybe it was Stevens or Smith. It could have started with an 'S', but I'm not sure. You know who I'm talking about, right?"

Memories...

A long, long, long, time ago, during my college years... I was a volunteer working in an ER.

It was a fairly small ER, and I was allowed to do A LOT of things that volunteers today aren't. It was nice, because my help was genuinely appreciated, and I was made to feel like part of the staff.

Anyway, one day an elderly lady came in with trouble breathing. While the doctor examined Mrs. Gasping, the nurse and I hooked her up to some oxygen. She went to turn on the O2, handed me the oxygen mask, and asked me to put it on the patient.

So I was placing it on the lady's face when the elastic band snapped over, pulling the plastic mask to the side.

To my horror, her whole nose flew off. We hadn't been told she had a prosthetic nose to replace one lost to skin cancer.

The nose clattered over the gurney and onto the floor. I screamed, thinking I'd somehow accidentally torn her nose off. The nurse shrieked. The doctor jumped back. I saw my entire dream of a medical career vanish.

Her husband started laughing, picked up the nose, put it in her purse, and set the oxygen mask on correctly.

I hid in the bathroom for a while.

Better living through pharmacology

2:28 a.m.

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

Mrs. Insomnia: "Hi, my husband sees Dr. Cortex for epilepsy."

Dr. Grumpy: "Is he having a seizure?"

Mrs. Insomnia: "Oh, no. He's fine. He takes Felbacetam."

Dr. Grumpy: "Okay, so why are you calling? Is he out?"

Mrs. Insomnia: "No, we have about 3 weeks left. But it requires an annual authorization from the insurance company to continue, and Dr. Cortex's nurse put the request in last week. Do you know if they've heard anything back yet?"

Dr. Grumpy: "No. Why don't you call his office when they open in the morning and ask?"

Mrs. Insomnia: "That's a good idea. Thank you, doctor. Have a great night."

A rose by any other name

Karen writes in:

"Dr. Grumpy, I've worked at different doctor's offices for over 20 years. But was still surprised when an infusion pharmacy rep came by recently and left his card and company information."

I'm going to have to agree with you, Karen. That's a TERRIBLE name for a pharmacy. Or pretty much any business (I wouldn't have dinner at DikPizza). Unless it's a sex shop.

According to the website, Dik is the owner's last name. And I respect that. Putting your name on a business is pretty universal. It's his name, and he's proud of it. But still, I think you have to take meanings into account, too. If your last name is Shithole or Fukme, you wouldn't want that on your cards. I think, in this case, going with your initials, or first name, or pretty much anything else, would sound better.

It also kind of distracts you from what the business does. I see "DikDrug" and I immediately assume they specialize in Viagra, Cialis, and Levitra "Here's a sample, why don't you see if it works? There's some magazines in the lobby bathroom."

Even more chilling (at least for a guy) is that DikDrug is an INFUSION pharmacy. This brings to mind painful images of Caverject and long needles being stuck in my winkie... I better cross my legs and end the post here.

Thank you, Karen!

Quote du jour

"I'm less aware of forgetting what I can't remember."

Squeeze

Last night I was watching a live CME presentation online. The discussion was about ways to measure stroke recovery by using a hand-grip dynamometer.

At one point the speaker said:


"The affected arm will be tested using a grip dynamometer for hand-jobs. Uh, I mean hand strength."


This led to a brief delay while the online panel composed themselves.

Reflections

Drug company advertising is, well, advertising. They're trying to get me to prescribe something.

I see drug ads all the time as I flip through journals. I ignore them. Most are meaningless collections of graphics, charts, and small print. But occasionally one will catch my eye.

A few years back Novartis ran a campaign for their Alzheimer's medication. Normally I'd have ignored it and turned the page, but the pictures were powerful and I stopped.

They've since moved on to more typical campaigns, but this one shouldn't be forgotten, so I'm going to share it here today.

Think of how you treat the elderly. Because someday it will be you on the other side of the mirror. Your newborns and toddlers and teenagers will be there someday, too. And the fragile old man/woman in front of you today was once you.

Overheard in the ER

Nurse: "I thought you were leaving AMA?"

Ms. Eword: "I am. You people here don't treat me right. I'm suffering, and in horrible pain, and you won't give me any Dilaudid. I'm never coming back to this dump."

Nurse: "So... why are you still here?"

Ms. Eword: "I want to finish my coffee."

Round & Round

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

Mrs. Feather: "I've been trying to reach you people all week. Why don't you return my calls?"

Annie: "It... looks like I've called you back 4 times. There was no answer, but I left messages each time."

Mrs. Feather: "I haven't gotten any of them. What number did you call?"

Annie: "The one you wrote on your info sheet, 867-5309."

Mrs. Feather: "That's my home number. I never answer that or check the messages. I only use that for outgoing calls."

Annie: "Well, it's the contact info you gave us. Is there a better number to reach you at?"

Mrs. Feather: "I use my cell phone for incoming calls. It's the only one I answer. It's the number my family tries to reach me on, but I don't give it out because I know you people sell phone numbers to telemarketers."

Annie: "No, ma'am, we don't sell or give out your personal information. So what's the cell phone number, so I can reach you next time?"

Mrs. Feather: "I'm not giving that out. It's only for family to reach me on, and no one else."

Annie: "Okay, but then how am I supposed to return your calls?"

Mrs. Feather: "You can call my home number."

Annie: "But you just told me you never answer that line."

Mrs. Feather: "Yes, but you can leave a message."

New Year's Day