Thursday, May 28, 2015

Memories...

Dr. Bond was an attending physician where I trained, known for insanely long wait times (like 3 hours or more). Although I never really understood why (and still don't) he had a loyal following of patients who put up with it and came armed with books, magazine, and coolers.

They'd wait in the lobby, then get taken back to an exam room where they'd wait a few more hours... and at some point he'd see them.

Until one night.

I was the neurology resident on call, and around 11:00 that night was paged by the head of the hospital's janitorial services.

Apparently, Dr. Bond's 4:45 patient had been put in a room... and forgotten. The staff left around 6:00, and the patient, used to Dr. Bond's usual waiting times, just stayed in there. Eventually he fell asleep (the badly-rattled cleaning lady actually thought she'd found a body).

So I walked across the street to the clinic (not exactly a great idea in that area) and briefly met with the patient. After determining that he wasn't dead (he'd just left his hearing aids at home) I called Dr. Bond to ask him what to do.

To his credit, he drove in to see the patient for the regular appointment that had been scheduled for that afternoon.

Wednesday, May 27, 2015

Maybe

Dr. Grumpy: "Any other questions?"

Mr. Rem: "Do you think I'm so tired because of all the Oxycontin I'm on?"

Dr. Grumpy: "That could do it... Um, I don't have you listed as taking Oxycontin."

Mr. Rem: "That's because I didn't tell you. I'm on 80mg three times a day."

Dr. Grumpy: "Um, yes, that could make you tired. Why didn't you tell me that?"

Mr. Rem: "I didn't think it was relevant."

Tuesday, May 26, 2015

"I'll be damned if I'm buying the next round."

Seen in a chart:


Monday, May 25, 2015

Memorial Day




Howard Gilmore was born in Alabama, and joined the navy when he turned 18. For an enlisted man to become an officer was a rarity at the time, but after 2 years he was appointed to Annapolis following competitive examinations.

He was, as a fellow officer described him, "one of the finest men I ever knew, but he was born under an unlucky star." While ashore in Panama during the shakedown cruise of the submarine U.S.S. Shark, he was attacked by local thugs and had his throat cut. He survived, but was left with a bad scar.

A few years later his first wife died, at a young age, from a disabling disease.

The day after the Pearl Harbor attack he was assigned to command the U.S.S. Growler, a submarine that was nearing completion. He supervised her during commissioning, and then took her through the Panama canal to fight in the Pacific.

Through 4 patrols, he led his crew on a series of successes. In July, 1942 Growler single-handedly attacked 3 Japanese destroyers, sinking one and badly damaging the other two. He was awarded the Navy Cross for this action. On a second patrol later that year he sank 4 Japanese merchant ships.

Shortly after Growler left on her 4th patrol, his 2nd wife fell down a flight of stairs and was in a coma for several months. Because his sub had already left, this information wasn't relayed on.

In early February, 1943, Growler was hunting off the Solomon islands, sinking one freighter and damaging another. Just after 1:00 a.m., in the early morning of February 7, 1943, she was stalking a Japanese convoy and preparing for a surface attack. Gilmore and 6 others were out on the bridge, planning strategy, when they were spotted by the enemy.

A convoy escort, Hayasaki, came after them, intending to ram the sub. In the darkness the course change wasn't immediately seen, and the enemy vessel got quite close before being detected. Gilmore ordered a sharp turn... but it was too late.

Growler struck the Hayasaki amidships. The collision bent the submarine's bow sharply to the left and destroyed her forward torpedo tubes. As Gilmore ordered the crew to clear the bridge and get below, they were raked with machine gun fire. Two crewmen were killed, and Gilmore was wounded.

The Japanese vessel, undamaged, raced away and turned around, intending to ram the submarine again and send her to the bottom. Gilmore, wounded and now the only living person on the bridge, couldn't get to the hatch quickly and realized the submarine had to dive immediately if she were to have any hope of surviving. He yelled "Take her down!", repeating the order to make sure he was understood. He knew this would leave him on the surface to drown.

Growler's executive officer, Arnold Schade, hesitated for a few seconds, but realized the situation, too. He followed the commander's last order and submerged to avoid the oncoming ship.

After hiding deep to escape Hayasaki for several hours, Schade brought Growler to the surface. The Japanese ship had left, and the submarine slowly cruised around the area looking for Gilmore while the crew carried out makeshift repairs. Though badly damaged, she was able to make it to Brisbane.

Commander Gilmore was never found. His posthumous Medal of Honor was presented to his widow when she recovered from her injury.


Thursday, May 21, 2015

Breaking and entering

Apparently, we missed the memo about yesterday being an early release day for a teachers meeting.

So the twins texted me while I was with a patient to say they were locked out, since neither of them had brought a key.

Fortunately, my last 2 patients of the day had cancelled, so we were able to close down early. On the drive home I ignored the text fight that broke out between the kids over whether the front or back yard was a better place to wait.

So I got home to find Craig planted in front of the garage, staring at his phone. He told me Marie had gone into the back yard to wait on the patio, and he didn't think that was a good idea for whatever reason. They were continuing to text insults to each other over which yard was better.

Such are the conflicts that shape our lives.

Anyway, I opened the garage, unlocked the door, and we went in.

To find Marie sitting in front of the TV, eating popcorn, and texting Craig back.



Dr. Grumpy: "Marie, how did you get in here?"

Marie: "I picked the lock on the back door."

Craig: "How did you do that?"

Marie: "I used my student ID to push the first lock in. Then I got Frank's old croquet set and bent one of the hoops around, so I could fit it through the crack and slide the second lock over."

Dr. Grumpy: "How come the burglar alarm didn't go off?"

Marie: "I twisted the croquet hoop the other way, like this, to reach around the corner and flip the alarm switch off."

Craig: "You didn't tell me you were inside! Why didn't you let me in?"

Marie: "Because you called me a bitch for going to the back yard."


We've lived in this house for 12 years, and this is the first time anyone's broken in. My neighborhood must be safer than I ever imagined.

Wednesday, May 20, 2015

Wednesday reruns

Dear Dr. Dipshit,

You sent a fax over to my office this morning that only said "PLEASE CALL ME ASAP TO DISCUSS MUTUAL PATIENT IMA DINGDONG!!! I'M AT 867-5309!!!".

I can only assume you did this because you are incapable of actually dialing a phone by yourself. Obviously, if someone at your end can look up a fax number, they could have found my phone number, too.

Mary brought it back to me about 3 minutes after it printed, and interrupted me while I was with a patient because it looked urgent.

I don't mind being interrupted, because a patient emergency should always take priority. So I called 867-5309.

The call was immediately transferred to your answering service, who told me your office was closed and offered to page another doctor on call, who likely had no idea why you were trying to reach me urgently. I begged the operator to see if your office had a backline she could connect me to, and she kindly did.

The lady (Jenny, I assume) who answered your back line obviously didn't give a shit. I told her I was Dr. Grumpy, and I was returning YOUR fax about Mrs. Dingdong. She told me the office was closed, and I should leave a message with the answering service. When I repeated that YOU HAD FAXED ME, she said you were having coffee with a drug rep, and didn't want to interrupt you (I guess it's better for a doctor to be interrupted when with a patient, huh?).

I told her that the fax said it was an emergency, so she sighed heavily (I could hear her rolling her eyes), whined, and said, "okay, let me go see if he's done".

I was then placed on hold for 2 minutes and 38 seconds (while I'm with a patient at my end) before another of your staff came on, said you were still with the drug rep, and asked me which patient it was on, what their date-of-birth was, and why was I calling in the first place? Could it wait until your office opened after lunch?

Sorry I hung up at that point, but I didn't want to scream and swear at some poor staff member that you'd stuck between us. Obviously, you and I have a different definition of "emergency".

And you can call me back if you need me. Or, better yet, just tell the patient to.

Tuesday, May 19, 2015

Brevity

Seen in a hospital chart. This was the entire physical exam performed by a neurosurgeon:


"Wait, he left out cyanotic."
For non-medical readers: NAD = "No apparent distress."




Here's another thorough note, this time by an internist:



"Pregnant or non-pregnant. Are there any other human health conditions?"




For all these years, I thought the neurological exam consisted of checking multiple subsystems covering cognition, Cranial Nerves, strength, coordination, sensation, reflexes... and other stuff. Apparently I was wrong, as this hospitalist's entire neuro exam shows:


Monday, May 18, 2015

Sunday night, 11:52 p.m.

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

Mr. Levodopa: "Hi, I'm a patient of Dr. Brain's, and I have Parkinson's disease."

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

Mr. Levodopa: "Well, he has me on Sinemet, one pill four times a day. Is that okay?"

Dr. Grumpy: "Are you having any problems? Or side effects?"

Mr. Levodopa: "Nope. This dose has worked great for me since 2012."

Dr. Grumpy: "Then I'd leave it as it is."

Mr. Levodopa: "Okay. I just call his office every week to make sure, and he's out of town right now."

Friday, May 15, 2015

Patient quote du jour

"I'm allergic to any and all manufactured products, regardless of what it is or what it's made from."

Thursday, May 14, 2015

Class




Mr. Skoal: "Then the pain radiates from the wrist to the thumb and..." (pauses, reaches onto my desk, and picks up my Diet Coke can) "Hey, doc, is this can empty?"

Dr. Grumpy: "Uh, yeah, mostly, w..."

Mr. Skoal: "Good, I need to spit out my chewing tobacco."

Hock


Wednesday, May 13, 2015

Top secret

Dr. Grumpy: "Hi, this is Dr. Grumpy. You guys referred Mrs. Spazzo to me, and I'd called earlier to have her most recent labs faxed."

Ms. Desk: "Yes, I sent them over a short while ago."

Dr. Grumpy: "I got them... but there's no lab results here. It just says they're 'abnormal'."


"How much more helpful can it get?"


Ms. Desk: "Well, that's because they're abnormal."

Dr. Grumpy: "Okay... but this doesn't tell me what's abnormal. Or even if they're high or low. The CMP has roughly 10-15 different things on it. Which ones are abnormal? Or is it all of them?

Ms. Desk: "Well, you're not the ordering physician. I don't see why you need more information."

Dr. Grumpy: "Because I'm trying to figure out what's wrong with the patient, and knowing which of her labs are off would help me. A lot."

Ms. Desk: "We have to protect patient privacy."

Dr. Grumpy: "But you referred the patient to me."

Ms. Desk: "Obviously, that was a mistake."

Click

Tuesday, May 12, 2015

"I'll have what he's having."

Seen in a hospital chart:



Monday, May 11, 2015

A very bad nut

Veruca Salt is the poster child for spoiled kids. With her demands, manipulative behavior, and spineless father, she's one of the most hated children of all time. Certainly, any parent (except her daddy) was thrilled to see her dumped down a garbage chute.




That's what you get when you give children everything they ask for. Trying to raise them to be responsible adults involves saying "no." A lot.

But, in today's world of health care, spoiling patients is apparently the goal. Even when it's against their own best interests (such as keeping them alive).

In case you haven't been near a hospital recently, "Patient Satisfaction Scores" are now the big thing. This isn't just some bullshit public-relations crap. Under the Medicare guidelines, 30% of a hospital's reimbursement is based on them. As opposed to, say, surviving brain surgery with a good outcome because of excellent care.

30% of Medicare money is a pretty decent chunk of change for any hospital. So they go along with it.

Because, ya know, if you hit the ER with crushing chest pain it's more important that someone immediately offers you a light snack than slaps an EKG on you and calls a cardiologist.

Of course, patient surveys don't ask questions about "are you happy that you had a complete recovery after your cardiac arrest/massive stroke/traumatic high speed rollover accident?" They ask if you were pleased with the food service. Or if the nurse smiled enough. Or if the call light was answered quickly.

Perspective is important. If you've suddenly lost vision in one eye, or can't move your leg, I'd hope they answer the call light quickly. If you're ringing it because you can't reach your iPhone, or your roommate is snoring too loudly, then a prompt response isn't as critical. But try telling that to the whiny person who's upset that no one answered her 5th call light in an hour (this time to ask when Survivor comes on) because the staff has been running a Code Blue across the hall. Minor things like someone elses health, or even their own, are beneath them.

The question about call lights is, really, on the survey. According to a recent article in the Atlantic, patient comments about "quality of care" have included:


"My roommate was dying... his breathing was very noisy.”

“The hospital doesn’t have Splenda.”

"I didn't get enough pastrami" (from a guy recovering after coronary artery bypass, FFS)



"This is a hospital, and you can't have it your way."

This experience was drilled into me over 20 years ago. I was a 4th year medical student doing an ICU rotation at a VA hospital (not known for having a big budget). One patient who'd been brought in for unstable angina the night before was yelling at me and a nurse because - get this - he hadn't gotten enough eggs for breakfast, and wanted more sausage links, too. My resident, a guy named Ivan, came over and said "this is not a hotel. We're trying to keep you from having to eat through a tube."

Of course (as is common at the VA) the guy yelled back that he was going to write to his congressman, and left AMA. But I digress.

The goal for us (the people on this side of the bed rail) is that you leave the hospital as reasonably intact as possible. This isn't always possible, but we do our best. But that doesn't mean you're going to get cronuts. Or HBO. Or someone to fix your TV at 2:00 a.m.

Getting you better (at least enough to go out and destroy your health again on your own watch) is our long-term goal. The guy recovering from diabetic coma may be pissed we won't give him cake and ice-cream, but that's not in his own best interests. So we have to say "no." He can go hit Baskin Robbins after leaving, but we can't control that. Like any parent trying to raise a child into a decent adult, saying "NO!" is critical here. As opposed to Veruca Salt's sniveling daddy who gives her whatever she wants and is raising a horrid brat.

Sadly, with patient satisfaction surveys, care takes a back seat. The guy who made it through a messy brain surgery may not be in a condition to fill it out, even though he had excellent care. But the junkie who didn't get Dilaudid as often as he wants? You can be sure he'll be ripping the hospital and nurses a new one.


"Look, bozo. You can't always get what you want."


Of course, the sword swings back at us, too. Let's say I give in to the "customer is always right" attitude they're pushing and let the patient have a little more bacon, or Morphine, or a cigarette. When they have another stroke you can bet they (or their heirs) will come after me with a lawsuit.

Patient satisfaction isn't necessarily the same as good patient care. In fact, it may be the opposite. One study found that the patients who were the most satisfied also had higher rates of medication use, hospital admissions... and death.



"Botched my surgery, but at least they had Splenda."

The hospital CEO's in their 25,000 square-foot offices, however, don't see it this way. They usually don't care about anything but revenue and getting that 30% out of Medicare's coffers. So a nurse who provides excellent care and catches early stages of an MI is going to be worthless compared to one who mixes up the wrong medications but has a nice smile and gives the diabetic extra ice cream. THAT'S the nurse who'll get the hospital a good survey score.

I suspect that, when this was written into Medicare law a few years ago, no one saw this as the end result. They likely believed patients (or "health care consumers") would be able to see the difference and judge accordingly. Unfortunately, human nature dictates otherwise.

I've bitched about this before, how completely worthless these online rating services are. Granted, the patient satisfaction surveys aren't quite the same, but they make the same mistake. Confusing personal satisfaction (which is subjective, variable, and wildly different from person-to-person) with good outcomes and quality of care (which can at least be somewhat more objective).

Your doctors, nurses, and all the others involved in your hospital care, are doing their best to make sure you get out of there in as good a condition as possible. But, like saying "no" to Veruca Salt, that doesn't mean it will always make you satisfied with us. But, for her own good, it would have made her into a better person. Or, in this case, a healthier one.



Thank you, SMOD!

Thursday, May 7, 2015

May 7, 1915





100 years ago today, in a factoid well known to school children, the R.M.S. Lusitania was sunk by a German submarine with a loss of 1198 lives.

And... that little snippet is pretty much all most people know about the disaster.

The details are forgotten compared to her erstwhile competitor, Titanic. Nobody made a blockbuster movie about her. Plenty of books have been written, but they often focus on the debated aspects. Was the ship a legitimate target? Did the British admiralty intentionally put her in harm's way? Was she carrying priceless paintings? These questions will never be settled, and I won't debate them here.

Americans are taught that the sinking is what brought the U.S. into WWI. Horseshit. It certainly contributed, but was only a small part. In fact, President Wilson fought like hell to stay out afterwards, and the U.S. didn't enter the war for another 2 years. The resumption of unrestricted submarine warfare in 1917 was a bigger factor. And, although mostly forgotten now, the Zimmerman Telegram was likely the event that finally pushed America into hostilities. Except for those of you who (like me) are fascinated by history, you've probably never heard of it.

A voyage then was a far cry from cruising now. Today's ships are designed for entertainment, with shows, games, shopping malls, climbing walls, mini-golf courses, and countless activities. They're rarely at sea for more than 2-3 days (at most) and frequent port stops are part of the attraction.

That wasn't the case in 1915.

To get some idea of intercontinental travel in the pre-flight age, think of this: You were in a large hotel for 10-20 days. You couldn't leave. You didn't stop in port until the end. The restaurants, though opulent, were the same. Your fellow travelers, and the crew, never changed. The only entertainment provided by the ship were small orchestras for 1st and 2nd class, an exercise room, and a meagre library. 3rd class slept in large dormitory-like rooms that doubled as their dining areas, and their only entertainment was whatever instruments and reading they'd brought. The North Atlantic crossing, arguably the busiest and most economically important of the era, was rainy, cold, and windy. The ships didn't have the stabilizing systems we take for granted today, and rolled with the choppy seas.

The Lusitania's stories are mostly forgotten (like the Empress of Ireland) probably because of the time scale involved. From start to finish the sinking took 18 minutes. In that sort of time, on a rapidly foundering ship, the overall reaction is rushed panic. The Titanic, in contrast, floated for 2 hours and 38 minutes after striking the iceberg. Enough time to avoid panic and for the norms of Edwardian society to dictate the events. Women and children first. Rich before poor. Americans & Britons before immigrants. Stories of the band playing to the end, of Isidor & Ida Straus choosing to die together rather than get in a lifeboat ahead of younger people, or the chief engineer who went back to carry out a crewman with a broken leg - with neither ever seen again. Thousands of stories in 158 minutes that immortalized the disaster.

In just 18 minutes, those on the Lusitania didn't have time to do much but try to get in a lifeboat. Most failed. Although (unlike the Titanic) she had enough lifeboats for all, the slope of the sinking hull, and the rivets holding it together, made it difficult to launch them. Many dumped people out before hitting the water.

But stories are there, you just have to look for them.

The Lusitania herself was a technological marvel. The first liner fitted with the revolutionary new steam turbines that today run everything from nuclear submarines to power plants. The first ship to have a central climate-control system (the ancestor of air-conditioning) to keep the interior at a steady 68°F, regardless of outside weather. The system also exchanged the air inside the ship 7 times every hour, eliminating the need to open portholes on a cold day. And, for a time, she was the fastest liner to ever cross the Atlantic.

On the antagonist in the tragedy, the submarine U-20, was a story. The ship had been identified as a large passenger liner, and Kapitanleütnant Walther Schwieger still had every intention of sinking her. He gave the order to fire, and it was the job of Quartermaster Voegele to relay it to the torpedo room.

But Voegele wouldn't. He told Schwieger he refused to carry out an order that would kill innocent civilians. Schwieger immediately relieved him of his post and had another officer do it. After returning to land, Voegele was court-martialed and spent the rest of the war in prison.

Very few stories are as popular, or been "re-booted" as much, as Peter Pan. From the Walt Disney cartoon, to Dustin Hoffman's "Hook," to 2003's "Neverland," the tale has been imagined and re-imagined, both in movies and theater, many times. And Tinkerbell now has her own spin-offs.

But the odds are you'd never have heard of Peter Pan or Tinkerbell if it weren't for a man named Charles Frohman. One of the leading theater producers of the era, he was instrumental in bringing the story to stage. First in London, then in America, he put J.M. Barrie's once obscure story in front of live audiences night after night. Frohman even had the title changed, from the original "Peter Pan - the Boy Who Hated Mothers" to the one you know: "The Boy Who Never Grew Up." It's as immortal as a tale can be.

Frohman died on the Lusitania, at age 58. Unable to jump into a lifeboat due to severe arthritis, and not knowing how to swim, he knew his life was coming to a close. He spent his last minutes with the wealthy Alfred Vanderbilt (age 37, also couldn't swim, and refused to get in a lifeboat ahead of women), tying life jackets to the nursery's baby baskets to make sure the infants would float. As the end approached Frohman turned to actress Rita Jolivet (who survived), and quoted from Peter Pan “Why fear death? It is the most beautiful adventure that life gives us." Then he disappeared under a surge of water.

As Margaret Mackworth and her friend Dorothy Connor watched the frantic rush for the lifeboats, Margaret commented that "I've always thought a shipwreck was a well-organized affair." Dorothy replied "so have I, but I've learned a devil of a lot in the last 5 minutes." An hour earlier, at lunch, Mackworth had told others at her table "It's been such a dull, dreary, stupid, trip. I can't help hoping that we get some sort of thrill going up the channel."

In Chicago, Illinois is Ambrose Plamondon Elementary School. Mr. Plamondon was a major American steel industrialist of the 19th century. When he died his son Charles took over the vast company... And, along with his wife, died on the Lusitania.

Another survivor who ran down to get her lifebelt remembered passing an open door, where inside a middle-aged woman cheerfully arranged and re-arranged her suitcase unconcernedly, as though they were about arrive in port.

In New York, Cunard's local director watched a crowd gather outside his office as news drifted in. He remembered watching a similar crowd outside the rival White Star Line office across the street 3 years earlier, and hoping it would never happen to him.

The worst of human nature was on display that night through America, Ireland, and Britain. Mobs attacked and burned business and homes owned by families of German descent, or even those with vaguely German-sounding names.

To the people of Queenstown (now Cobh), Ireland, fell the rescue. As the first S.O.S. crackled from the Lusitania, local fisherman (who'd just come in to unload from the morning) frantically untied their boats and headed back out to sea to save as many as possible. It was a motley collection of mostly sailing boats, a few faster ones with engines, and even some that were being paddled. Boys standing on the cliffs of Kinsale to watch her pass saw the explosion, and helped spread the alarm to local life-saving patrols. The exhausted fishermen worked into the evening to save as many as they could.

As the 767 survivors came into town on overloaded boats, the townspeople rushed blankets and food to the docks. They found places to shelter the fortunate ones - in homes, hotels, warehouses... anywhere there was space - until Cunard was able to make arrangements.

To the locals also fell the unenviable job of handling bodies that were picked up by boats or washed ashore for the next several weeks. Those that could be identified were sent home, but many were beyond that. So three large mass graves, with coffins stacked 2-3 high (some with 2 children put in them) were dug at the Old Church Cemetery. More were buried in Kinsale, at the Church of St. Multose.




Some of the victim's names were known only to their families, sadly being listed on the roster just as "Mr. Stanton's manservant" or "Lady Adam's maid."

In 1912, as the Titanic was about to leave port, the suction from her powerful propellers pulled another liner, the S.S. New York, away from the dock. The 2 ships missed colliding by roughly 3 feet before tugboats could push them apart. Now, 3 years later, the New York was linked to another tragedy. The American government chartered her to bring citizens, living and dead, back to the states. She carried the bodies of Charles Frohman, the Plamondons, and many others.

Survivor Herbert Ehrhardt took off his shoes and gave them to a shivering man in his lifeboat while awaiting rescue. They didn't quite fit, but the man said they'd do. The next day Ehrhardt (and many others) went to a Queenstown shoe store to replace them. As he waited to be helped, he noticed his original pair lying discarded on the floor. He laced them back on and left.

U-20, the submarine that sank Lusitania, ran aground off Denmark in November, 1916, and was subsequently demolished. What's left is roughly 1200 feet from shore, under sediment. The conning tower was removed and is at a local museum.

Captain William Turner of the Lusitania survived the sinking when a wave washed him off the bridge. He was pulled from the water, unconscious, by the crew of a fishing boat. Although exonerated by the inquiry, public opinion held him to be at fault for not taking preventative measures. His wife and sons left him, and he never saw them again. He was assigned to command the ship Ivernia in 1917, which was sunk in the Mediterranean by a submarine. He survived again, but never returned to sea and died in 1933.

Kapitanleütnant Walther Schwieger was killed in September, 1917, when his next submarine struck a British mine.

The last survivor of the Lusitania, Audrey Lawson-Johnston, died at age 95 in 2011.

The once-beautiful Lusitania lies, collapsed on her starboard side, in 300 feet of water off Ireland. While the bow section of the Titanic still evokes a sense of grace and majesty, the Lusitania is little more than a large scrapyard. Her much shallower depth makes her susceptible to the effects of tide, weather, and temperatures. The attack by U-20 was also just the beginning. Countless times in WW1 and WW2 there was concern U-boats were using the wreck to hide, and so it was aggressively depth-charged by destroyers to scare them off.

The hundreds in the mass graves, whose identities will never be known and whose families never saw them again, are marked at the Old Church Cemetery by a single large stone.




Wednesday, May 6, 2015

Reportable case

Seen in another doctor's note:


Tuesday, May 5, 2015

Nudge, nudge, wink, wink

Apparently, the Shipley School in Pennsylvania held a spring fundraising auction this year.

Which included this item:


"Is that why they call them blue movies?"
Thank you, W!

Monday, May 4, 2015

Skool Nerse Time

This is Mrs. Grumpy.

Today, as I was leaving for the day, I was accosted in the parking lot by a wild-eyed mom.


Wild- Eyed Mom: "DO YOU WORK HERE?!!!"

Mrs. Grumpy: "Um, yes..."

Wild-Eyed Mom: "YOU'VE GOT TO HELP ME! MY SON IS MISSING! PLEASE!"

I text the twins I'll be a few minutes late. I take her to my office, turn the computer back on to get records (which takes effing forever, thanks Windows), and dial up a security guard to come help.

Mrs. Grumpy: "Okay, what's his name?"

Wild-Eyed Mom (hysterical, but trying to calm down) "Claude Rains."

Mrs. Grumpy: "All right, let me see if any reports are in... When did you last hear from him?"

Wild-Eyed Mom: "When he got home from school."

Mrs. Grumpy: "Wait... So he's already been home?"

Wild-Eyed Mom: "Yes. He got home from school, and was watching TV, and I went to go shower. When I came out he was gone!"

Mrs. Grumpy: "Okay, so you came back to the school even though you knew he'd gotten home safely from there?"

Wild-Eyed Mom: "Yes! Isn't this what you people do?"

Before I could answer the computer stopped searching.

Mrs. Grumpy: "You said Claude Rains? We don't have a Claude Rains in the database."

Wild-Eyed Mom: "Oh... He just texted me. He's back home now. He went to help a friend who had a flat bike tire. What did you say?"

Mrs. Grumpy: "He's not in our database."

Wild-Eyed Mom: "Well, he doesn't go to this school."

Mrs. Grumpy: "Then why..."

Wild-Eyed Mom: "He goes to Daniel Simpson Day Middle School."

Mrs. Grumpy: "That's not even in this district... Why did you come here? Do you live nearby?"

Wild-Eyed: "No, I figured you guys had better computers and stuff that could find him."

Mrs. Grumpy: "We..."

Wild-Eyed: "Obviously, I was wrong. I wish you'd have just told me that in the first place."

She left.

Monday, April 27, 2015

The Out-of-Towners

Due to family visiting this next week, I'll be taking time off from the blog. See you next week!

IG

Friday, April 24, 2015

Zzzzzzzzzzzzzz

Dr. Grumpy: "Let's check the list... Lipitor, Atenolol, daily Aspirin... Are you still taking Ambien to help you sleep?"

Mr. Nicklaus: "No, I stopped it a while ago."

Dr. Grumpy: "What do you do for your insomnia now?"

Mr. Nicklaus: "I turn on the golf channel. Works better."

Thursday, April 23, 2015

Dinner theater

This was left on the office voicemail yesterday:

Him: "No one is answering."

Her: "I heard. It says they're helping someone else."

Him: "Should I leave a message? Or call back later?"

Her: "Just call back later. Did you find that recipe?"

Him: "Yes, I emailed the link to you."

Her: "That one sucked. You can't make lemon chicken like that!"

Him: "How do you know? Have you ever tried?"

Her: "No, but anyone with half a brain can see it was crappy recipe. You'd need more chicken than that."

Him: "It made perfect sense. I went to cooking school, you didn't. Trust me."

Her: "Really? Have you ever used it? All that tuition, and I don't think you've set foot in the kitchen except to make chips-in-a-bowl with a side of beer."

Him: "Oh, like you're capable of anything more complex than eggs."

Her: "At least I know what a good lemon chicken recipe looks like. You don't."

Him: "Okay, what?"

Her: "It should have, um, chicken, and, uh, lemon."

Him: "It had both."

Her: "It didn't have enough chicken."

Him: "Fine. Why don't we just do take-out?"

Her: "Whatever. Why don't you call the neurologist back and see if you can get through now?"

(click)

Wednesday, April 22, 2015

Knowledge



Recently a patient brought his daughter, a 4th year medical student, to the appointment with him. She nervously asked me about making her imminent, and bizarre, leap from medical student to doctor. She felt like someone was going to tell her she wasn't really qualified to be a doctor, that her whole 4 years of med school were some sort of trick, and that she was really a fraud.

And... I agree. Not that she's a fraud, but that it's how I think most of us feel at that point. Actually, it's how ALL of us feel. It's just that some won't admit it. I will.

Attention medical students and residents: THIS IS NORMAL. You just don't realize it until you're actually going through it.

As a 3rd year medical student this terrified me. I was seeing REAL (OMG! REAL!) PATIENTS and had no idea what I was doing. The attendings would point out the substantial gaps in my knowledge and I'd feel like there was absolutely no way in hell I'd ever know that much.

Toward the end of my 3rd year was a rotation with Dr. Griffith, an absolutely brilliant internist. He was a nice guy, but always made me feel like I knew little, simply because he had all the answers I didn't. Seated next to him at an end-of-year lunch, someone pointed out to him that he'd now been an attending for 6 years (yeah, in retrospect, he's not that much older than me). I quietly asked him "and do you still feel like you don't know anything?" He laughed and said "I don't know anything."

And, folks, it never goes away. I've now been an attending physician for over 15 years, much longer than Dr. Griffith was at that time. And I still feel like I don't know anything.

I think the issue is that inwardly we're still the same people who went to college, made it through medical school, survived residency... but we're still ourselves. Somehow we expect that, by being given the title of "Doctor" we're suddenly endowed with a sort of medical omniscience... and it doesn't happen. I don't feel any smarter today than I did when I stepped out of grade school, or high school, or college. Even though I KNOW that through learning and training I've amassed a decent amount of medical knowledge, it's not something that any of us is consciously aware of.

In my experience, the only way any of us realize how far we've come is when we compare ourselves to someone at a previous stage in our training. When I have the occasional medical student or resident spend a few days with me, I'm amazed at how much more I know about neurology than they do, even though I don't feel any different than I did at their stage. It's only in comparison to those behind us that we realize how far we've come.

And, if they ask me if I ever feel like I don't know anything, I tell them "always."

Good luck, Haley!

Tuesday, April 21, 2015

I'm a magnet

I stopped at the bank to deposit some checks. They know me, and so the teller and I are chatting a bit. While we're talking an elderly woman steps up to the other teller.


Teller: "Hi, Mabel. How are you doing?"

Mabel: "I need to know if my debit card was activated. It doesn't seem to be working."

Teller: "Let me see it..." (Mabel hands her a card) "Mabel, this is a library card."

Mabel: "It is?" (opens wallet) "What about this?"

Teller: "That's your driver's license."

Mabel: "Well, it's still not working at the ATM."

Teller: "It's not supposed to. Let me check your account."

Mabel: "Can you see if I have any overdue books?"

Monday, April 20, 2015

Beware of the Dragon

Seen in a hospital chart:




For my non-medical readers: it was supposed to say "hemorrhage." The joys of Dragon software.

Friday, April 17, 2015

FRANK!!!!!!!!!!!!!

"I didn't do it Dad." (snicker) "Really!"

Thursday, April 16, 2015

1:58 a.m.

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

Mrs. Call: "My husband is having a seizure. He sees Dr. Nerve for epilepsy."

Dr. Grumpy: "Okay, do you have a medication to give him for seizures?"

Mrs. Call: "It's in the bathroom. Can't I just hold the phone next to him and you tell him to stop?"

Wednesday, April 15, 2015

Scum

One of my patients is dying from a brain tumor. He has severe pain from a number of related and unrelated issues, and since I'm the doctor he sees the most I've ended up prescribing his narcotics.

Recently, though, his pain has been worsening, and nothing I've given him is touching it. I've tried increasing pill strength and changing narcotics, to no avail.

Because of his severe pain, I finally admitted him directly to the hospital, to try and get things under control with injectable narcs while I decided on the next step. As always, I told his wife to bring in his pill bottles for me to review.

Sitting in the room with them yesterday, I began making my usual notes on what pills, how many were left in each bottle, etc., to make sure he was taking them correctly. As I opened one narcotic bottle after another I found that, in spite of different labels, they all contained the same white tablets with the same number stamped on them.

So I took out my phone to look up the number.

All the bottles were full of generic Tylenol. No wonder nothing touched his pain.

Further investigation revealed his daughter, who was the one picking them up, was selling the pills and replacing them with Tylenol before taking them to her elderly parents.

I hope you rot in hell.

Tuesday, April 14, 2015

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?"

Monday, April 13, 2015

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!

Thursday, April 9, 2015

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.

Wednesday, April 8, 2015

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?"

Tuesday, April 7, 2015

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!

Monday, April 6, 2015

Beware of the Dragon

Seen in a hospital chart:



Friday, April 3, 2015

Math

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


"And the rest become zombies."

Thank you, Diver Dan!

Thursday, April 2, 2015

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?"

Wednesday, April 1, 2015

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.

Tuesday, March 31, 2015

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

Monday, March 30, 2015

Catch-22

From a medication denial fax I received last week:


Friday, March 27, 2015

Define "valuable"

Invitation a reader recently received for a market research survey:




Thank you, Dr. M!

Thursday, March 26, 2015

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.

Wednesday, March 25, 2015

Research

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

Thank you, Webhill!

Tuesday, March 24, 2015

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.

Friday, March 20, 2015

Quote du jour

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

Thursday, March 19, 2015

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."

Wednesday, March 18, 2015

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."

Tuesday, March 17, 2015

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."

Monday, March 16, 2015

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."

Friday, March 13, 2015

Thursday afternoon whatever

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

Dr. Grumpy: "You mean photophobia."

Ms. Chlorophyll: "Whatever."

Thursday, March 12, 2015

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.
 
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