Winning bid

Dr. Grumpy: "How's the diet going?"

Mrs. Atkins: "It's on hold. I ordered that diet book you suggested, but the person I bought it from on eBay screwed up."

Dr. Grumpy: "What happened?"

Mrs. Atkins: "They sent me this instead. I'm actually going to the post office to mail it back later."


She reached into her bag, took out a book, and held it up. It was called "Working with a Transsexual: A Guide for Coworkers."


Dr. Grumpy: "That's definitely not the diet book I recommended."

Mrs. Atkins: "No. And you just know someone out there was hoping to get this book to help them at work, and is instead staring at my diet book."

Sunday night check-out

Dr. Grumpy: "In room 734 is a guy with arm weakness since a shoulder injury. I've ordered an MRI of his brachial plexus."

Dr. Nerve: "Where do you think the problem is?"

Dr. Grumpy: "Uh, in the brachial plexus."

Dr. Nerve: "You should have made that clear."

When dogs fly

Me: "What kind of dog is she?"

Mrs. Owner: "She's a Morkie. It's a cross between a Yorkie and a, um, Maltese Falcon."

Follies

I saw a guy for headaches recently. Nothing unusual in his story, but, since he'd never had them before, I ordered a brain MRI. I figured, like most of them do, it would come back normal.

I wasn't even close. It came back, not just abnormal, but weird. All kinds of odd changes. Nothing easy to point a finger at, like a stroke or brain tumor. But definitely not normal.

Like I always do in these cases, I called the neuroradiologist who read it, and discussed the case. He was pretty certain of the strange findings. We reviewed all the different causes, and none of them fit with his history.

Because of the unusual nature of the findings, I got a copy of the MRI and took it to another neuroradiologist for a 2nd opinion. She absolutely agreed with the first guy.

So, I was stuck with something weird, not easily explainable for his case. After hospital rounds the next night I went to the hospital library, and spent some time looking up the findings, what can cause them, how you work them up, etc. I had Mary bring him in, working him in over lunch to give me extra time to discuss the news with him and answer his questions.

He came in, and I took some time. I explained the findings, and what they might mean. I went over the steps to work them up further, including a spinal tap and labs. He and his wife sat in silence as I went over everything. Finally, I opened up the floor for questions.

Mr. Sternberg: "These abnormal findings, could they be caused by lymphoma?"

Dr. Grumpy: "You have lymphoma?"

Mr. Sternberg: "Had. About 10 years ago."

Dr. Grumpy: "How did they treat it?"

Mr. Sternberg: "I had chemotherapy, and they did radiation treatment on my whole body and head."

(Pause. I pick up the phone and call the neuroradiologist, who says that, yes, absolutely, the changes are typical for someone who's had radiation).

Dr. Grumpy: "Yes, they're likely from radiation. Why didn't you tell me you had lymphoma?"

Mr. Sternberg: "I didn't think it was important. By the way, my headaches are gone."

Today's lesson people: When the neurologist asks about your past medical history, lymphoma and brain radiation are things you want to mention.

Seen in a chart

Nothing can make a doctor look stupider than an EHR (computerized charting) system.

Smoking is, to me, a good example. We all ask "Do you smoke?" There are 3 basic answers: "Yes," "No," and "I used to."

That isn't so hard. I mean, yeah, occasionally you'll get someone who uses snuff or has some other answer, but in 98% of cases the answer is one of those three. My somewhat primitive human brain can handle them pretty well.

Of course, when you turn this simple question over to an EHR, you get crap like this:

What the HELL does that bizarre combination of phrases mean? In a few lines the patient has gone from being a smoker, to a chain smoker, to a non-smoker, and back to a smoker. And what's an "aggressive non-smoker" anyway? Someone who whips out a fire extinguisher and sprays people who light up?

They tell us these kinds of programs make medicine easier and safer for all involved. I think they're smoking something.

Vacation time!

Heading out for a bit. Be excellent to each other!

Seen in a chart

I'm so behind on the new drugs.

Technophobe

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

Mrs. Analog: "Yes, I faxed you a copy of my records last week, and Dr. Grumpy decided not to take my case. So I'd like them back."

Mary: "He deleted them already, I'm sorry. If we're not going to be seeing you, we don't keep a copy."

Mrs. Analog: "WHAT? You should have just mailed them back!"

Mary: "Ma'am, you sent them to our digital fax number, so all documents faxed go directly to the e-mail. There were never any paper records here."

Mrs. Analog: "But you still could have mailed them back. I mean, how much effort would it have been to pull them out of the e-mail, put them in an envelope, and mailed them back to me? I'd have paid you for the postage."

Mary: "You... can't do that. It's a digital file."

Mrs. Analog: "Nonsense. And they were my only copy!"

Mary: "But... you said you faxed them. Isn't there a copy of them on your fax machine?"

Mrs. Analog: "Is there supposed to be? When I fax stuff the feeder just spits out paper on the bottom."

Mary: "Those are the things you just faxed."

Mrs. Analog: "Does that mean the paper is digital now? Can't you fax the email to me at least?"

Thud

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

Ms. Panic: "I need refills on all my meds! I just realized I'm out!"

Annie: "Okay... hang on... Looks like we have you on 3 of them. You need all 3?"

Ms. Panic: "YES! I'm all out!"

Annie: "Our schedule shows you have an appointment tomorrow?"

Ms. Panic: "I know! I'll be there! But please call these in now, I'M ALL OUT!!!"

Annie: "Okay, will do."


The next day...


Dr. Grumpy: "How you doing?"

Ms. Panic: "A lot better since I was last here! Thank you."

Dr. Grumpy: "Annie called in your refills yesterday. I guess you were out?"

Ms. Panic: "Yeah, I ran out a week or two ago."

Dr. Grumpy: "A week or two ago? Did you get them yesterday?"

Ms. Panic: "No, I decided not to. I don't think I really need them anymore."

Beam me up

Dr. Grumpy: "Is that Cochran with or without an E on the end?"

Mr. Trek: "No E."

Dr. Grumpy: "Okay."

Mr. Trek: "Zefram Cochrane has an E at the end."

Dr. Grumpy: "Who's that?"

Mr. Trek: "Sheesh. He invented the warp drive in 2063."

Uh..., yes?

Last night I was doing an online survey about the treatment of epilepsy, and this question came up:

Memories...

Years ago my father-in-law hit me up for Viagra samples. I was happy to give him some, but Viagra reps generally don't call on neurologists.

But, because I like the guy, and Christmas was around the corner, I asked my drug rep about it. She was able to have some shipped to me (probably thought they were for me). So I packed them up and mailed them to his house.

About 2 weeks went by, and I didn't hear from him. I began wondering if they were lost in the mail, so I called him. Turned out, due to heavy snow fall and being retired, they hadn't been down to their mailbox for 1-2 weeks. He thanked me for having sent them, and put his wife on the line to chat.

While she and I were talking I heard some crashing noises in the background, followed by a loud mechanical roar.

Dr. Grumpy: "What's all that noise?"

Mother-in-law: "No idea what he's doing. He tore up the garage looking for something, and then just ran out in the driveway with the snowblower. I wonder what he's up to?"

I told her I had to take a call from the hospital, and got off the phone.


Note: This post is just for the humor. For those who want to write in about the medical-legal aspects of this... It happened early in my career, when I was young and naive. Time and experience have taught me not to do things like this.

Fandom

Lady comes in.

Mary: "Hi, can I help you?"

Lady: "I have an appointment with Dr. Grumpy at 10:45."

Mary: "Oh, okay, you're a bit early. Have a seat and he'll take you back when he's done with the current one."

Lady: "Okay."

She walked over to the center table and combed through the 20 or so magazines on it, scanning the covers, then setting them down. Then she did the same with the handful of magazines and patient pamphlets piled on the 2 corner tables. Failing to find anything of interest, she walked over to the wall rack and carefully picked through the dozen or so magazines there before finding one she liked.

Then she sat down and, until called back for her appointment 20 minutes later, used it only to fan herself.

Conundrum

I never know what to do with these.

MRI's and MRA's and all our toys are good. They can see stuff we never could, even 5-10 years ago. So, as they get better, they find more.

But that's not always good

I have a lady in her mid-70's. A few years ago her internist did a brain scan on her and found a small aneurysm.  It wasn't related to her symptoms, but since he didn't know what to do with it, he sent her to me.

I reassured her that it wasn't anything. But, since some small aneurysms will grow into large ones, I'm stuck following it. Otherwise, if she drops dead of a ruptured aneurysm at some point, her family can sue me because I didn't look to see if it was getting bigger. CYA. This is defensive medicine at its finest, and, once you've been sued, you'll practice it, too.

Of course, she could refuse the test, but most people don't. As long as it's covered by their insurance, why the hell not?

So every few years I order a repeat study, though at this point it's starting to get silly. I mean, even if it were growing, surgery at this point would pose a bigger danger to her than the aneurysm. But she wants the test, her daughters want the test, and my personal feelings take a back seat to covering myself.

The repeat study this year was, of course, unchanged. Fine. I sent her a letter saying we'd repeat it in 3 years.

I got a call a few days later... from the hospital, asking me to come see her.

Leaving the MRI place she'd fallen while getting in her car, breaking her hip. Which needed surgery. So now she's in the hospital, post-op, and completely whacked out from unfamiliar surroundings and pain meds. So they needed a neurologist to come see her.

Am I medically or legally, at fault for this? Not really. But I still feel guilty about it. I mean, she could also have fallen at the grocery store or walking to her bathroom, with the same outcome. But, instead, she fell while having a test that I wasn't even sure was needed, but was somewhat obligated to order. Yes, she and her daughters insisted on having the scan, so it's their decision, too.

But I still feel bad. Because of guidelines and defensive medicine a nice older lady had a scan she didn't necessarily need, and in an odd way suffered a complication of it.

Will this change how I practice? Probably not. The culture of defensive medicine is so ingrained into American physicians that it's hard to do otherwise. But stories like this make me wonder what the real cost of it can be.

Seen in a chart

Relationships

This was scribbled on a patient info sheet, apparently from someone confused over their family who's who.

Which, of course, brings to mind this song...

Germ theory

This past Saturday, Craig had a meeting at Ye Olde Burger Dive with some dads and other Boy Scouts to plan out their annual trip to Camp Wannahockaloogie.

I dropped him off and drove away. After I'd run errands for an hour or so, he texted he was done, and I went to get him. He came out, carrying a styrofoam take-home box, climbed in the Grumpymobile, and we headed home.

We chatted about the meeting, and camp, and the food at Ye Olde Burger Dive. When we got to that topic he asked "Hey, Dad, you want some fries?"

"Sure," I replied.

Craig opened up the styrofoam box and leaned over. It was full of fries and maybe a third of a cheeseburger. So I grabbed some fries and ate them.

Dr. Grumpy: "They have good fries."

Craig: "Yeah, I like them."

Dr. Grumpy: "You didn't finish your burger?"

Craig: "Are you kidding? I love their food. I put my whole lunch away."

Dr. Grumpy: "Huh? Then what's in there?"

Craig: "Oh, some kid named Jake got that but couldn't finish it, and then he had to leave halfway through the meeting 'cuz he wasn't feeling well. So I asked for a box to take his stuff home for Mello."

Memorial Day

Memorial Day, 2016 has the unusual occurrence of falling close to the 100th anniversary of one of the most terrible naval battles of all time. Therefore, to mark both, I'm going to devote this year's column to a service member from another country.

The WWI Battle of Jutland was the first, and only, large scale battle between the massive dreadnought battleships that had come to exist in 1906. There were other clashes of them, but none on this scale.

HMS Dreadnought, when built in 1906, immediately made all previous battleships obsolete. Her existence set off a massive naval arms race that involved the British Commonwealth, America, Germany, Austria-Hungary, Spain, France, Japan, the Ottoman Empire, Russia, Italy, Brazil, Argentina, and Chile.

On the night of May 30th-31st, 1916, both the German and British battle fleets left harbor, each thinking they were luring the other into a trap. All together there were 250 ships, carrying 105,000 men, on a collision course. Surprisingly, both fleets almost missed each other, and the battle was started by a small Danish freighter innocently blundering between them. Both sides sent small ships to investigate her, which sighted each other.

The battle raged on & off into night and early morning. When it was over 25 ships of various types had been sunk and 8,645 men killed. Although these losses were small compared to the terrible land war being fought in France, they were shocking for naval combat. And the battle, surprisingly, changed very little. Germany won a tactical victory, but the overall strategic victory went to Britain. The course of WWI hadn't changed.

And that's my summary. For those who want to learn more, I recommend watching this. Otherwise, just skip to the next paragraph.







The flagship of the British battlecruiser fleet was HMS Lion, led by Vice Admiral David Beatty. It was his division that had the first main contact with the Germans.

On board Lion was Major Francis Harvey of the Royal Marines. Born in Kent to a family with a long military tradition, he joined the navy at age 14. There he was quickly recognized for his proficiency in languages, gunnery, and debate.

He worked his way up through a series of ships, eventually becoming a gunnery instructor and in charge of training the crews of the navy's Channel Fleet. When World War I started, he was assigned to Lion, commanding one of her main gun turrets.

At Jutland, midway through the battle, Lion was hit several times by Admiral Hipper's flagship Lutzow. One shell penetrated the armor of Harvey's turret and exploded inside. The result blew the roof & front off the turret, killed or seriously wounded every man inside, and set fire to the bags of cordite explosive that were being readied for the next round.

Harvey was still alive. He'd had both his legs blown off, and was losing blood rapidly. Death was coming quickly. But he saw that the hatch separating the turret from the ammunition magazine below was jammed open by a piece of metal. When the burning cordite exploded the fire would spread down into the magazine and destroy the entire ship.

He dragged himself to the speaking tube and ordered the magazines below him flooded with sea water. When the fire did indeed spread a moment later, the ship was saved by his action.

The order was issued with Harvey's last breath. Immediately after giving it he collapsed dead.

Winston Churchill later wrote "In the long, rough, glorious history of the Royal Marines there is no name and no deed which in its character and consequences ranks above this."

Harvey was posthumously awarded his country's highest decoration, the Victoria Cross. His wife and son received the medal from King George V at Buckingham Palace. In 1973 his son loaned it to the Royal Marines Museum, where it can be seen today.

Harvey himself was buried at sea the day after the battle. His name is inscribed at the Chatham Naval Memorial. He was 43.

Memories

 

The person who ran the residencies where I trained was a neurosurgeon, who had a ginormous house. Like 15,000 square feet. 3 stories. With more rooms than anyone could possibly want.

And a really, really, really old cat.

One of the other neurology residents (Dr. Brownnose) volunteered to house-sit for him, which involved taking care of the cat. It was diabetic, and needed frequent insulin shots.

One night, she lost track of the cat. Since the doors had been closed all day, she knew it was somewhere in the house.

I was woken up at 11:45 that night as she frantically called the rest of the neurology residents to come over and help her find the missing pet (taking care of cats was beneath the dignity of the neurosurgery residents, who wanted nothing to do with it).

Because, after all, "accidentally killed neuroscience program director's beloved family pet..." just doesn't look good on a resumé.

We drove from the inner city by the hospital out to suburbia. And, in the wee hours of the morning, 5 of us were combing back & forth through this massive house with flashlights and cat treats, trying to find the feline and hoping it was still breathing.

I don't remember anymore who found it, asleep beneath an antique chair. It got carried downstairs for its insulin shot, giving us this hateful "I can't believe you monkeys woke me up" look.

We made her take us out for happy hour the next week. And boy, did we run up a tab.

My life of crime

It's late afternoon. I'm at my desk, returning calls.


Mr. Stroke: "Hello?"

Dr. Grumpy: "Hi, Mr. Stroke, it's Dr. Grumpy. You had an appointment with me yesterday."

Mr. Stroke: "Yes. What's up?"

Dr. Grumpy: "I got your hospital records, and it doesn't look like they did an ultrasound of your heart."

Mr. Stroke: "Is that important?"

Dr. Grumpy: "Yeah, because the clot may have come from there. I'd like to have Annie set one up, so she'll call you tomorrow."

Mr. Stroke: "Okay, excuse me, what? HEY!"


Pause


Dr. Grumpy: "Hello?"

Ms. Daughter: "WHO IS THIS? YOU SHOULD BE ASHAMED OF YOURSELF!"

Dr. Grumpy: "This is Dr. Grumpy, I saw your dad yesterday. You were at the appointment."

Ms. Daughter: "You even sound like him, too. I'm going to let him know as soon as he opens in the morning that his charts have been hacked. My father is an elderly veteran, and here scum like you are trying to steal his identity and medical information."

Dr. Grumpy: "No, this really is Dr. Grumpy. All I'm trying to do is set your dad up for a heart study."

Ms. Daughter: "Uh-huh. I know how you people operate. I've got the number you called from on the caller ID, and I'm turning it over to the police."

Dr. Grumpy: "It's my office number."

Ms. Daughter: "Rot in hell, asshole."

Click

MARY!!!!!!!!! HELP!!!!!!!!!!!

Dr. Grumpy: "Any changes in your health since I last saw you?"

Ms. Doda: "No, nothing ... Oh wait, I had surgery last fall."

Dr. Grumpy: "Okay, was it..."

Ms. Doda: "I got boobies! Implants! Check these girls out!"

(Whips off shirt)

Seen in a chart

This is how a note I received from a neurosurgeon ended. Thanks, guys, that really helps.

Bon appétit!

Like many offices, we have a small dish on the front counter full of generic hard candies (peppermints, butterscotches, Werther's, Jolly Ranchers, etc.).


Lady waiting for her appointment comes up to front counter.


Lady: "Can I have one of these candies?"

Mary: "Sure. Help yourself."

Lady: "Thanks. I didn't have time to get breakfast today."


She picked up THE WHOLE JAR, carried it back to her chair, and in the space of about 5 minutes unwrapped and crunched through about 20 pieces of hard candy.

Then she brought the empty jar back to Mary, full of wrappers.


Lady: "Thanks."

Overheard at the nurse's station

"BITCH! You're the worst nurse ever! Get the fuck out of my room! But first, get me more morphine!"

May, 1927

89 years ago this week...

Charles Lindbergh is a household name. Children learn at a young age that he was first person to fly non-stop between New York and Paris in the Spirit of St. Louis.

But 2 weeks before his famous flight, a brave pair of Frenchmen took off from Paris planning to fly nonstop to New York, and have their names enter the history books instead of their American rival.

Francois Coli and Charles Nungesser

Instead, they vanished.

Francois Coli and Charles Nungesser (ages 45 and 35) were both excellent pilots. Coli was a highly decorated veteran of WWI, who'd been making record-breaking distance flights across the Mediterranean Sea for several years. Nungesser was also a talented flier, and France's 3rd most successful ace in WWI. Like their American contemporary, Charles Lindbergh, they were chasing the $25,000 (in 1924 money) Orteig Prize, which would be awarded for the first nonstop New York-Paris flight across the Atlantic.

They spent 2 years modifying a Levasseur PL.8 biplane, adding extra fuel tanks and reinforcing the structure for the long flight to come. The engine was run in the factory for over 40 consecutive hours to test its reliability. The bottom of the plane was rebuilt so it could land on water, and their plan was to arrive in front of France's gift to America, the statue of Liberty, to complete the record breaking journey. A wheeled carriage would be used for take-off from land, then dropped. The plane was painted white and named L'Oiseau Blanc - "The White Bird."

Their route was an arc over the northern Atlantic, taking them from Paris, across the English Channel, England, and Ireland. On the other side of the Atlantic they'd gradually turn south and fly over Nova Scotia, Maine, Boston, and finally come down in New York harbor. They had enough fuel for 42 hours of continuous flight, and were going at a time of year known for better weather. Coli was one of the best navigators of the era - in an age where flights over water relied entirely on celestial navigation. Like most planes, they had no radio.

The guts to do this sort of thing must have been remarkable. For the most part we take long-distance flying for granted today. But at that time they were using technology as unproven to them as the earliest space flights were to another generation. The planes were wood, metal, and cloth. Engine reliability was iffy at best. Navigation was largely educated guesswork. The White Bird's cockpit was open to the elements, and behind the wings. They had nothing over their heads, so were exposed to wind, rain, and cold.

At 5:27 a.m. an May 8, 1927, they took off from Paris's Le Bourget Field, dropping the wheeled sled that was used for the take-off. Within minutes the electric signal had been received in New York that the White Bird was on its way. Crowds in Paris watched as they disappeared into the distance. They continued over England and Ireland on their way into the history books. The last man to see them was a priest in Carrigaholt, Ireland.

On May 10, large crowds gathered in New York to watch the historic arrival. No one had ever flown from Paris non-stop, and it was a big day in the development of the amazing airplane.

But it was not to be. The White Bird never appeared. After several hours of waiting, the crowds dispersed, not knowing what had happened to the 2 brave Frenchman.

And 89 years later, we still don't know.

For 2 weeks, the armed forces of France, England, Canada, and America scoured as much of the Atlantic and northeastern North America as possible. But no trace of them was ever found. Writing of their attempt afterwards, Lindbergh noted they'd "vanished like midnight ghosts."

For several years it was assumed they were victims of a storm, or navigational error, or mechanical problem. The North Atlantic is cold, gray, foggy, and unforgiving. If they were forced to come down far from land, they'd have no real chance of survival. A navigation error could put them far off course, heading for desolate areas as their fuel ran out.

But the odds are that they didn't fail entirely.

As years went by, disparate stories drifted in. Fishermen in remote Newfoundland communities seeing a white plane pass overhead on May 9 (in that era an airplane sighting was a rarity). Reports from small towns through Nova Scotia and into Maine, where residents noted either a white plane going by, northeast to southwest, or the sound of an airplane engine above the clouds. One local newspaper even reported a "mystery plane" passed overhead on that day. These were from areas likely unaware of the White Bird's attempt.

The stories, initially disconnected, meant little. But as researchers dug there were 2 common threads: they all took place on May 9-10, 1927, and all were in a line that sequentially followed the final leg of White Bird's planned course to New York City. In that era there were no other planes that would account for them.

And the reports stopped somewhere in Maine.

Anson Berry (died 1936), a hermit outside of Machias, Maine, knew nothing of the White Bird and didn't read newspapers. But on trips to buy supplies, he told many townspeople about a day in May, 1927, when he'd heard a low-flying plane engine sputtering somewhere above the clouds... Followed by a loud crash in the distance.

Rumors have cropped up over time. A plane wreck seen in a lake. A ruined engine, possibly from a plane, found in the forest and sold for scrap. A few odd pieces of metal and wood have been collected in the area, but nothing that can clearly proven to have been from the plane.

Two weeks after the White Bird vanished, Charles Lindbergh made the first successful non-stop New York - Paris air crossing in the Spirit of St. Louis. Although evidence suggests the Frenchmen beat him by 2 weeks, their exact landing place and fate remain a mystery. Perhaps someday it will be solved.

On the cliffs of Étretat, in France, is a monument to mark the last place Nungesser and Coli flew over their homeland as they headed west.

Near their take-off spot at Le Bourget field is a monument to both they and Lindbergh, inscribed "A ceux qui tentèrent et celui qui accomplit" ("To those who tried and to the one who succeeded").

At the nearby French Air & Space Museum, is the only proven relic of their brave journey: the wheeled sled that the White Bird used for take-off, and then jettisoned.

Time out

All fine here, but due to some unanticipated family craziness I have to take a week or two off from the blog to catch up on other stuff. Sorry, but I promise that I'll be back.

Harmony

Him: "Am I your token black patient?"

Me: "No. Am I your token Jewish doctor?"

Pause

Him: "Dude, I like you."

Just another manic Monday

Mrs. Fennec called, asking for an urgent appointment. Mary had an afternoon slot open, and put her in.

She came in with her dog. This isn't uncommon in my practice, so I didn't think much of it.


Dr. Grumpy: "So what's going on? Mary said you had an emergency?"

Mrs. Fennec: "Yes! Fluffy ate my bottle of Strokoxx!"

Dr. Grumpy: "Uh, are you okay?"

Mrs. Fennec: "I'm fine! But what should we do about Fluffy?!!!"


(I look at Fluffy. He looks at me and cocks an ear to the side.)


Dr. Grumpy: "Well, you should take him to your vet to get this checked out."

Mrs. Fennec: "BUT YOU'RE THE ONE PRESCRIBING THE STROKOXX!!!"

Dr. Grumpy: "Yes, but I have no idea what it does to dogs. Or how to handle it. Or much about dogs at all. Who's your vet? Why don't I call and tell them what's going on, and you can head over there..."

Mrs. Fennec: "It's YOUR medication. You prescribed it! So you should be handling any issues it causes."

Dr. Grumpy: "Well, yes, as far as people go. But not dogs."

Mrs. Fennec: "You're refusing to treat Fluffy because he doesn't have insurance!"

Dr. Grumpy: "This has nothing to do with money. I'm not a veterinarian. You need to take him to someone who knows what to do for him."

Mrs. Fennec: "This is ALL YOUR FAULT, and I'm going to send you the vet's bill!"

(She got up and stomped out. Fluffy, I swear, looked back and winked at me.)

Specificity

Dr. Grumpy: "Have you ever had physical therapy?"

Mr. Vague: "Yeah."

Dr. Grumpy: "Where?"

Mr. Vague: "I don't know. It was a therapy place."

Dr. Grumpy: "Do you remember where it was?"

Mr. Vague: "Somewhere around Grumpyville, I think."

Seen in a chart

Friday re-runs

While at Local Grocery after work I was sighted and approached by a patient.

An Alzheimer's patient.

Bill.

Bill: "Uh, excuse me? Hello."

Dr. Grumpy (looking up): "Yes, I, oh, uh, hi"

Bill: "I know you, um" (he leaned forward, and I realized I had my hospital ID clipped to my shirt) "You look familiar, um Ibee Grumpy?"

Dr. Grumpy: "Yes, Bill, how are you?"

Bill: "Don't tell me, it'll come! I know! You work here!"

Dr. Grumpy: "No, Bill, I'm..."

Bill: "Can you tell me where breakfast cereals are? My wife asked me to get some Corn Flakes."

Dr. Grumpy: "Uh, aisle 16, that way, about halfway down."

Bill: "Thank you."

As he walked away I realized he had a box of Corn Flakes in each hand.

Mary's desk

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

Ms. Stannum: "I need to see the doctor, but want to ask some questions first."

Mary: "Okay, what can I help you with?"

Ms. Stannum: "I'm having terrible problems on my left side, and I need to know what's going on. But I can't have any tests, so is he the kind of doctor who will order them?"

Mary: "Well, that's something he would have to decide during the appointment, but I can tell you that he does order MRI's and labs, and...."

Ms. Stannum: "DIDN'T YOU JUST HEAR ME? I said I can't have any tests! I'm deathly allergic to the metal used in needles to draw blood and those electrodes they put on your skin!

Mary: "All right, but..."

Ms. Stannum: "And the magnetic rays and X-rays that scanners give off devastate me. I mean, I've had them in the past from all my other neurologists, but then I'm bed-bound for weeks afterwards. WEEKS. Last time I had to take short term disability until I could recover from the effects they have on my brain waves."

Mary: "Maybe you..."

Ms. Stannum: "And I can't take any pills. The chemicals they use in them are all poisons to me. I've nearly died from them thousands of times. LITERALLY. THOUSANDS! So I need a doctor who can help me get better, but who won't make me have any tests or take any pills."

(pause)

Mary: "I don't think Dr. Grumpy and you would be a good match. You might want to try another office."

Ms. Stannum: "That's the problem with modern medicine. Nobody cares about helping sick people."

(click)

Texting with Frank

I wandered out to put stuff in my car, to discover a large penis drawn on the dirty back window.

Obviously, I need to wash my car more often.

This sort of thing generally indicates Frank is the perpetrator, so I texted him.

April 11, 1755

Today is International Parkinson's Disease day.

Parkinson's Disease is something I deal with a fair amount. As most know, it's a progressive neurological disease typically characterized by tremor, imbalance, and slowness of movement.

And that's all I'm going to say about it here.

So why did I bring it up? Because the man behind the disease is fascinating. Mostly remembered now only by the neurological disorder he described, there was a lot more to him. Probably one of the more remarkable figures of his (or any) time.

James Parkinson was born on this day in 1755. His father, John, was a London pharmacist and physician. While a medical student, in 1777, James and his father received medals for successfully resuscitating a man who'd hung himself.

During medical school he wrote a pamphlet about his experiences called "The Medical Pupil." Perhaps this could be seen as an early example today's med student blogs. In words that still ring true 240 years later, he opined that "a sympathetic concern, and a tender interest for the sufferings of others, ought to characterize all those who engage themselves in the profession, the object of which should be to mitigate, or remove, one great portion of the calamities to which humanity is subject.”

Preach it, brother James.

In 1784, upon John's death, James took over the practice. It was a successful one, treating rich and poor alike. He also served as the supervising physician at a large local mental institution. He married Mary Dale, and they had a total of 8 children, 6 of whom survived to adulthood.

Parkinson was politically active and, for the time, radical. He strongly supported equal rights for the poor (OMG!), voting rights for women (gasp!), and the inclusion of "ordinary citizens" as a major portion of government. He campaigned extensively for decent treatment and legal protection of the mentally ill, realizing that those with serious illnesses were often incapable of recognizing their actions.

He wanted annual elections to make sure parliament turned over with "new minds" frequently, and supported the French Revolution across the channel. He wrote and published numerous political pamphlets, but to protect his family and practice wrote under the pen name "Old Hubert." When a political group he was involved in was falsely accused of plotting to assassinate King George III (the Pop-Gun Plot), Parkinson refused to testify against his friends. Eventually all charges were dropped when it was revealed they were trumped-up by political opponents.

During his medical career he published a treatise on gout and went on to write the first English language description of acute appendicitis. He and his son (also James, and also a doctor) were the first to prove that death from appendicitis was due to visceral perforation and infection.

As a member of the Association of Apothecaries (later its president) he saw a key act passed in 1815 that, for the first time, regulated the standards to which doctors and pharmacists had to be trained. He was also instrumental in passing laws concerning apprenticeships, setting goals for training and protecting the apprentice from abuse.

He wrote medical & science columns for popular newspapers on such varied subjects as chemistry, nosebleeds, and hypochondria, and also published scientific papers on topics as disparate as lightning, fossils, and geology.

In the 1810's, based on observations of both his own patients and  individuals he'd seen walking around London, he first recognized the characteristic tremor and shuffling gait of the disease that today has his name. He also differentiated between the types of tremors commonly seen - a key diagnostic point still used by neurologists today.

In 1817 he published his landmark piece "An Essay on the Shaking Palsy" in which he described the main features of the disorder. The accuracy of the paper in describing the condition is made all the more remarkable by the fact that neurology as a field didn't exist at the time. Jean-Martin Charcot, the Frenchman who would go on to found my medical specialty, was born 8 years later in 1825. It wasn't until 1877, 60 years after Parkinson's essay, that Charcot himself named the condition Parkinson's Disease. His English colleague, William Gowers, agreed with Charcot's eponym.

Sadly, this discovery obscured many of his equally remarkable accomplishments.

Besides those interests mentioned above, Parkinson's scientific curiosity led him in many directions. He examined rock specimens at length and wrote a breakthrough treatise on the sediment patterns and fossils seen through the British Isles, recognizing the organization and significance of different rock strata.

He authored 2 books on fossils from around the world, describing them as earlier stages of currently living animals (Darwin's theory of evolution wouldn't be published for another 40 years). He also did his own black & white illustrations for the books, while his daughter did the color plates.

A species of Ammonite, a long-extinct relative of the modern octopus and squid, was named after him. So was an ancient branch of the turtle family. He has the unusual distinction among scientists of having both a disease and fossils attached to his name.

In 1823 the Royal College of Surgeons presented him with an award for his extensive body of work, noting “The fruits of your exertions are distinguished by the stamp of simplicity and truth. They express the most laudable zeal in the pursuit and the promulgation of knowledge, for the benefit of mankind.”

James Parkinson died on December 21, 1824 of a stroke, very close to where he was born and spent his entire life and practice. He was buried at St. Leonard's church, though no stone was placed and the exact location of his body is unknown.

Seen in a chart

Making the call schedule

Dr. Brain can be a bit of a snob. Sometimes I play stupid just to irritate him.


Dr. Grumpy: "Okay, I'll take call the first weekend of the month, Dr. Cortex the second, and..."

Dr. Brain: "You'll have to put someone else on for the last weekend. My wife and I have tickets for Andrea Bocelli."

Dr. Grumpy: "Okay, I'll put Dr. Nerve on there, so if you'll take the third weekend it should all work out."

Dr. Brain: "These are FRONT ROW tickets. I paid a fortune for them."

Dr. Grumpy: "Okay, now for the following month..."

Dr. Brain: "Do you know how hard it was to get these tickets?"

Dr. Grumpy: "Um, no. Who's Andrea Bocelli?"

Dr. Brain: "A singer."

Dr. Grumpy: "I've never heard of her. Is she like Lady Gaga?"

Dr. Brain: "No! He's a man, and..."

Dr. Grumpy: "Was he the guy I saw who had a small stroke last summer? I think you said he played guitar at a coffee place?"

(pause)

Dr. Brain: "I'm available any weekend the following month."

Great moments on call

Dr. Grumpy: "Can I get a swallow evaluation on Mrs. Stroke, in room 63?"

Speech therapist: "Of course. Do you want African or European?"

April 1st

Since so many of you are forwarding this to me, I figure I might as well share it for those who haven't seen it.

Seen in a chart

I often have that last problem myself:

For the non-medical readers, it's supposed to say "volume depletion."

Thank you, M!

Thunk

Mr. Migraine: "My headaches have been terrible, especially with all the rain we've been getting."

Dr. Grumpy: "Hmmm. Well, we have room to increase your Spazinox dose, so let's try going to 100mg twice a day."

Mr. Migraine: "Will that help the headaches?"

Dr Grumpy: "I'm hoping so. Let me..."

Mr. Migraine: "I don't get it. How will increasing the dose make it rain less?"

Dr. Grumpy: "No, it makes it harder for your nerves to start a headache."

Mr. Migraine: "Okay... I guess that makes more sense."

Honesty

Seen in an ER chart:

March 17, 2016

Dr. Grumpy: "Come on, kids. We need to leave for school."

Frank: "Anyone seen my backpack?"

Craig: "Let me get a granola bar for breakfast."

Marie: "Can you get me one, too?"

Craig: "Okay."

Frank: "Oh, I left it in the car last night. Never mind."

Marie: "Craig, you can't wear that today."

Craig: (throwing granola wrapper in trash, shoving bar in his mouth) "Why not?"

Marie: "It's St. Patrick's Day. You're supposed to wear green."

Craig: "My green shirt is in the closet. This one was closer."

Marie: "You need to go change."

Craig: "I'm not going to change shirts. We have to leave."

Marie: "But you need to put green on!"

Craig: (reaches into trash can, grabs something) "Fine. Happy now?"

Spring break

Heading out for the kids' Spring Break. See you guys next week!*

*Okay, realistically I won't see you. All I ever see is my monitor. But you know what I mean.

20 years

About a week after my Dad's death, I had my med school 20th reunion. I'd already bought tickets, and Mrs. Grumpy insisted I go. A while back I wrote about my thoughts on it.

I flew in, got a rental car, checked into my hotel, and went over to campus. I left here 20 years ago, the day after graduation, and haven't been back since.

This was the view from my hotel. The alumni travel rep lied about it being a nice neighborhood.

"It's overlooking a grassy park."

The control panel for the elevator didn't exactly inspire confidence, either:

It was very strange. I arrived in the evening and went over to campus to walk around.

The classrooms were empty. I stood in the cavernous room where I'd been a first year medical student, failed the first anatomy test, and somehow pulled out a passing grade when it was over. I walked through the lounge where my friend Bryan had, I swear, used the microwave to heat up a squirrel he'd shot in his yard (he was from Wyoming) for lunch. The anatomy lab was now locked up with a security code, a precaution that hadn't been necessary 20 years ago.

The next day I spent more time re-discovering the campus.

When I checked in they gave me an ID tag, held to my shirt by a magnet. The warning on the back was in tiny letters, and most people likely wouldn't have noticed it until it was too late.

"Why am I suddenly so lightheaded?"

I entered the library, marveling at how much it still looked the same. Of course, now there were computers and iPads everywhere, but still the same big study tables I'd once memorized the Krebs cycle at. The same broken toilet in the basement bathroom, that likely has been plugged since I was last here.

My steps took me to the gym, where I stared down at the track and remembered a younger version of me who somehow found the time to run 5 miles a day and weighed 75 pounds less. What the hell happened to him?

They'd given me a bright red bag at check-in that said "ALUMNI" on one side, with a bunch of guides and requests for money in it. "Help us build the new administrative retreat chateau in the Alps."

My first impulse was to hide the red "ALUMNI" bag under my jacket, because carrying it openly would make me stand out.

Then I realized that I DO stand out. I mean, this is a small university campus, full of bustling 18-25 somethings. I'm a paunchy, balding, 50-something guy, and the bag doesn't matter. Hell, it probably keeps me from being arrested arrested for trespassing.

I quietly wandered through the meditation garden behind the old church. I'd spent a lot of time here, walking over when I needed a break. My favorite bench was still there, and as I sat on it again I thought of all the times I'd been there trying to find the will to go back and study, to not quit and fly home..., to just go on. Somehow I'd made it, and am still not sure how.

I stopped in front of a statue from 1920, placed there to give thanks for those who'd been spared the twin horrors of WWI and the flu pandemic, and to remember those who hadn't. Hard to believe that at that point it was believed WWI would be the final limit on man's inhumanity to man, while time would go on to prove it wasn't even close.

I walked across the street to my old apartment complex, and stared up at the place I'd lived in for 4 years while becoming a doctor. I'd grown up a lot emotionally in there. I thought of my roommate, Enzyme, and the crazy couple next door. And the night we sabotaged them.

Back then it had been rough in a lot of ways. I'd never left my hometown before, and in the mid-80's was moving halfway across the continent to go to medical school. Dad and I loaded up a big U-Haul and made the 3-day drive here. He'd paid for my apartment. I drove by places where he and I had once gone, and I wanted to send him a picture to show what it looked like now. And had the sickening realization that I can't anymore.

Some of the events of alumni weekend were comical. They included a pub crawl. I don't know about other people, but, at 20 years out from medical school, my ability to consume and handle alcohol isn't what it once was. When I last saw the sign-in sheet it only had one name on it (brave soul).

When I'd graduated, the front hallway of the med school had a huge display of posters, showing the pictures and names of every graduating class going back over a hundred years. As med students we'd look at the spot where our class would be featured... someday. I'd moved away before they put it up, so one of the things I'd really wanted to do was finally see my picture up in the hallway.

So I went into the hallway... and the display was gone. Of course, no one who works there now has any recollection of a display EVER being there. One told me she'd once heard a rumor about it, and that the posters might be in storage somewhere with a plan being to turn them into a digital display at some point (presumably before the sun becomes a red giant)... But I didn't get to see my picture up.

I took the tour of my medical school later that day. It included the dreaded anatomy lab, which still smells like it did when I was there, and likely as it did since the first time classes were held there (anyone who went to medical school knows, and hates, the "anatomy lab smell." It never comes out in the laundry).

The medical students now have THEIR OWN EXERCISE ROOM, with machines and everything, attached to the med school. Kids today. When I was their age, I had to walk to the school gym, through snow, uphill both ways.

Going through the student resource rooms it was good to see the school was still as technologically cutting edge now as it was then. I was told these gadgets are still in frequent use:

WTF do you get the plastic sheets? Or still using the same ones?

"We keep these around to get alumni donations."

On the night of the reunion party I took the elevator up to the 4th floor, and an elderly couple got in with me. She clearly had Parkinson's disease. Her husband was frail and old, stooped over a cane. I suddenly realized he'd been one of the key internal medicine attendings when I was there, the brilliant physician-sleuth we all dreamed of being. We were all both terrified and in awe of him, and here he was, looking so much smaller than I ever remembered. I introduced myself, and thanked him for all he'd done to help make me a doctor. Then I held the door for them when we got to the stop for his class's gathering.

The actual reunion, was, as these things are, interesting. It was good to see my classmates again, and see where life had taken them. All are still in practice, scattered across the country like pins on a map. I've never been a particularly outgoing person, but was happy to chat with my old classmates for a few hours. The tables in the back were taken up by their spouses, who looked horribly bored. I'm glad Mrs. Grumpy decided to stay home.

It's hard to believe that, when we first met, we were all young and, for the most part, really believed in what we were doing. Medicine was a religion, a calling, at the time. To some extent I think we still believe in what we do, but 20 years of fighting insurance companies, narcotic seekers, sleepless weekends on call, 70-80 hour weeks, diminishing reimbursements, bogus disability claims, and living in fear of malpractice suits will dim the fire. But they're all still good people, and it was nice to find we still care. We're different, with varying religious and political beliefs, but we still have more in common than not. Unlike government officials it was easy to discuss such things respectfully and without animosity, and still like each other.

At some point in the evening, as it got late, something told me it was time to leave. I don't know what it was. Whatever I'd been looking for by coming back here... I'd found it. Not being a person who does goodbyes well, I didn't say any. I set my drink down on a table and quietly slipped away. I had no regrets.

I walked back to my rental car across the darkened campus. It was a nice evening. I passed the occasional student heading to the library or gym. The groups sitting under trees talking. The young lovers holding hands. I liked it here, but it wasn't my place anymore. That was 1000 miles away, and I had a plane flight in the early morning.