Sunday night

It's 11:18 p.m. I'm fast asleep, and my phone rings.

Dr. Grumpy: "Hello?"

Dr. Brain: "Hi, Ibee? It's me."

Dr. Grumpy: "What's up?"

Dr. Brain: "I couldn't sleep, so I'm reading the new issue of 'Journal of Obscure Neurological Diseases of Burkina Faso.' Have you looked at this months?"
 
Dr. Grumpy: "Uh, it's 11:30 at night and I was..."

Dr. Brain: "They're COMPLETELY changing the diagnostic criteria for Fleaglehart's Syndrome! I disagree with the entire thing. I mean, now they're considering visual changes to be helpful, but not diagnostic, of the disorder. They're increasing the importance of mental status changes, and now there are more than the 2-3 standard MRI findings we're used to."

Dr. Grumpy: "Uh..."

Dr. Brain: "This is RIDICULOUS! I mean, how many cases of Fleaglehart's Syndrome have you seen that would fit this new criteria?"

Dr. Grumpy: "Look. It's 11:30 at night, you woke me up, and honestly I've never seen a case of it."

Dr. Brain. "Really? Neither have I. Okay. Have a good night."

The visitor

I'm in my office looking through MRI reports.


Mary: "Hey doc, there's a drug rep up front, says he needs to talk to you. Says it's not a sales call."

Dr. Grumpy: "Okay, just send him back."

(drug rep comes in)

Dr. Grumpy: "Hi, Matt. What's up?"

Drug rep Matt: "Sorry to bother you, but I was told to come talk to you about a weird request my company got."

Dr. Grumpy: "About..."

Drug rep Matt: "A patient of yours called my company, and said you'd authorize her to get 4 replacement injector pens and we just had to contact your office. I thought I'd come by myself, since we hadn't heard anything about this from you guys."

Dr. Grumpy: "Did you hear what happened to the pens?"

Drug rep Matt: "That's the weird part. She contacted 3 service reps, told one the pens were stolen, another that they were never delivered, and another that her boyfriend backed over them with his car."

Long pause

Dr. Grumpy: "Actually, she and some friends got drunk and then tried using them to pierce their ears."

Long pause 2 

Drug rep Matt: "Are you shittin' me?"

Dr. Grumpy: "Nope."

Drug rep Matt: "I'm going to assume your story is the correct one?"

Dr. Grumpy: "That's the one she called me with Saturday morning."

Drug rep Matt: "I'm pretty sure we don't have a program to replace pens lost through, um, misadventure."

Dr. Grumpy: "Believe me. I understand. We've been dealing with her all week."

Long pause 3.

Drug rep Matt: "Thanks. I'll let you go. Wow. This sounds like something you'd read on a med-blog."

Annie's desk

Ms. Myelin: "Hello?"

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

Ms. Myelin: "Oh, good. Did you order my new MS pens?"

Annie: "No, I just got off the phone with your insurance, and they won't replace pens that are damaged that way."

Ms. Myelin: "That's what they told me, too!"

Annie: "You called them yourself?"

Ms. Myelin: "Yes, I figured you'd just ignore me. Do you have any idea how long they made me sit on hold?"

Annie: "Um, yeah."

Ms. Myelin: "This is ridiculous. I need this medication, and my insurance company won't give it to me, even though it's been authorized and I've paid all my premiums."

Annie: "Well, you get a limited number of pens a year, and that's what they've given you. You broke 4 of them using them for something they weren't designed for."

Ms. Myelin: "Like it's my fault they put such a cheapshit needle on that it broke."

 Annie: "I..."

Ms. Myelin: "Can't you tell them that they were defective? Or that I broke them defending myself from a burglar or something?"

Annie: "I need to point out here that you called them before me, and told them the real story."

Ms. Myelin: "I didn't think they'd be such uncaring assholes. Whatever happened to 'honesty is the best policy'? I'm pretty sure the insurance phone bitch was laughing at me."

Annie: "Well, at this point the only way you can get them replaced is to pay cash."

Ms. Myelin: "WHAT? Do you have any idea how much this costs? It's $1200 for each of their crappy pens."

Annie: "There's really nothing else I can do"

Ms. Myelin: "Can Dr. Grumpy pay for them? He's the one who prescribed it, after all. I just took his advice."

Annie: "No. Maybe you should ask Ashley and Amy for help?"

Ms. Myelin: "I'd never ask my friends to do that for me."

Saturday

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

Ms. Myelin: "Hi, I see you for Multiple Sclerosis, and I'm on that drug you inject with a special pen?"

Dr. Grumpy: "Yes?"

Ms. Myelin: "I need to get 4 new pens ordered for the month. The ones I have are all broken, so I'm going to run out."

Dr. Grumpy: "A month's worth of injector pens were all broken?"

Ms. Myelin: "No. I mean yes. I mean, they are now."

Dr. Grumpy: "Did they get shipped to you broken?"

Ms. Myelin: "I don't think so."

Dr. Grumpy: "So how are they all broken?"

Ms. Myelin: "Well, for Cinco de Mayo me and my girlfriends were at the Smashed Iguana. They were having tequila shot specials, and they do that thing where they pour margaritas right in your mouth? Anyway, we came back to my place to crash, and while we were sitting around Ashley said she'd been meaning to get her ears pierced in new places. Amy volunteered, cause she once did her own when she was in high school and said she'd been meaning to do the same. But I didn't have anything that would really work, then remembered I had my MS drug injector pens and they have pretty sharp needles, so we..."

Dr. Grumpy: "You used MS injector pens to pierce your ears?"

Ms. Myelin: "Well, yes. I mean, on a Friday night at 11:30 it's not like the place at the mall was open."

Dr. Grumpy: "I'll talk to Annie and get back to you on Monday."

Friday reruns

Dr. Grumpy: "So at what point did you call 911?"

Mr. Young: "When I realized she was having a seizure."

Dr. Grumpy: "How long after the seizure started was that?"

Mr. Young: (looks at Mrs. Young, both blush, look at floor) "Well, I didn't call right away, because we were, um, having sex at the time, and when she started shaking I just thought she..."

Dr. Grumpy: "Got it. So how long did the seizure last?"

Losses

Mary: "Let me give you these forms... Here's a pen... can I get a copy of your insurance card?"

Mrs. Card: "No."

Mary: "Do you have it with you?"

Mrs. Card: "Yes, but I don't know Dr. Grumpy yet. Can I give it to you after the visit, if I think he deserves to get paid?"

Rug

Dr. Grumpy: "At your last visit we started Flingase, how's that been going?"

Mrs. Scalp: "It's helped my migraines, but causing a lot of hair loss! I feel like I'm going bald!"

Dr. Grumpy: "Yeah, like we'd talked about, that can be a side effect."

Mrs. Scalp: "The trade-off just isn't worth it. I want to try something else."

Dr. Grumpy: "That's fine. Let me..."

Mrs. Scalp: "Here's this."

(puts a Ziploc bag on my desk)

Dr. Grumpy: "Uh... what's that?"

Mrs. Scalp: "It's all the hair that's fallen out. I've been saving it for today."

Dr. Grumpy: "I, um, see."

Mrs. Scalp: "Since you were familiar with the drug I figured you'd know a way to put it back on. Isn't there a Flingase antidote?"

Dr. Grumpy: "No, but it'll grow back with stopping the drug."

Mrs. Scalp: "Will it all be back by this weekend? I have a wedding to go to."

Dr. Grumpy: "No..."

Mrs. Scalp: "Well, this is a lot of hair." (picks up bag) "Do you have glue or something?"

Honesty

Seen in a chart:

Parking

My office parking is okay. Not great, not horrible. Generally anyone can find a space, but they may have to park farther than they like (we do have plenty of handicapped spots).

I have one patient, Mr. Thuesen-Hale, who perennially complains about it. It's almost Seinfeldian, were it not for him being so enraged. Mary even gave him a list of neurologists who might have a better office lot than I do, to no avail.

So at his appointment last week, he showed up with a bunch of papers. They looked like forms for work.


Dr. Grumpy: "Any other questions?"

Mr. Thuesen-Hale: "Yes, I have this for you."

Dr. Grumpy: "Is it for your job?"

Mr. Thuesen-Hale: "No, it's a parking ticket."

Dr. Grumpy: "A parking ticket?"

Mr. Thuesen-Hale: "Yes. Because of your crappy parking here I got a ticket last time for being on the street. So it's your responsibility to pay it." (shoves papers at me)

Dr. Grumpy: (not reaching for them) "I'm sorry you got a ticket, but I'm not going to pay it."

Mr. Thuesen-Hale: "That's unacceptable. You chose to rent in this building, so it's your problem. PAY IT!"

Dr. Grumpy: "I'm not going to do that."

Mr. Thuesen-Hale: "Look, if you don't pay it I'm not coming back!"


It's funny how some people think that's a threat.

Random pictures

Okay, time to hit the mail bag for stuff you guys have sent in:

First we have this doctor's office:

"How's the weather down there?"

From the "but don't do it right now" department of driving safety:

"Gee, this sounds like a great place to live"

"I guess the gardens are by the rear entrance."

From the music store (for those of you who remember what one was).

"Better not look in the other bin" department:

People who can't spell are watching you:

And, lastly, a reminder of those good old days of pharmacy:

Modern medicine

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

Ms. Thirst: "Yes, I need to make an appointment with Dr. Grumpy."

Mary: "Okay, our next available is on Thursday, at..."

Ms. Thirst: "Wait, first of all, do you offer a beverage service in your lobby?"

Mary: "Uh, no. There's a water fountain down the hall, by the... Hello? Hello?"

Wednesday reruns

Mrs. Powder: "Sorry I'm a few minutes late, I had to drop my husband off at the ER."

Dr. Grumpy: "Is he okay?"

Mrs. Powder: "Oh he's fine. He was cleaning his gun and shot himself, again."

Dr. Grumpy: "Oh my..."

Mrs. Powder: "You'd think he'd get over being such a baby about it. I made him wait in the car until I'd finished the laundry. Anyway, at the last visit you had me try Nomig for headaches, and I like it. Do you have any more samples?"

Mystery

Last week I got a letter from an insurance company about a patient's medication. No biggie. Happens a lot.

The letter said my patient's prescription authorization was expiring next month, and that I needed to fill out and resubmit the forms to get it covered for another year. Okay, I do that a lot, too.

But this letter, in the interest of protecting patient privacy, didn't give me their name. Or the medication. Or their diagnosis. Not even an ID number or birthday. Zilch. Zip. Nada.

In fact, across the top of the letter it said:

And I must admit they were right. The only name on the letter was my own.

So what am I supposed to do? I want to help the patient, but a quick look at my computer says I currently have 1,043 active patients. At least 278 of them are on a medication that requires me to re-authorize once a year. I can't start calling all of them, either. Ones who are coming due in the next 2 months? 44 per my machine. That's still too many for a random guess.

No easy answer here.

Sadly, the way these things usually play out is I'll only know who it is because they go for a refill and are told the medication is no longer covered because uncaring Dr. Grumpy never bothered to do the authorization. So they call and yell at me because they're not going to get their medication "AND IT'S ALL YOUR FAULT!" (my kids love that line, too).

I'm a big believer in patient privacy. I work hard to protect it. But when information about a patient, and a potentially life-saving medication for them, is kept secret from the very doctor who's prescribing it... We've reached a new level of insanity.

Franz Kafka (not my patient)

Supercalifragilisticexpialidocious!

Seen in a chart:

Of course, there's only one medicine that treats it all.

Memories...

One night, just after starting my internship, I got called to pronounce a patient dead.

How hard can that be?

They paged me just after midnight. As I took the elevator to that floor I realized that... I had no idea how to pronounce someone dead.
 
OH, SHIT!

My medical school had covered all kinds of stuff about diagnosis and treatment of the living, and, in retrospect, zilch about how to tell if someone is dead.

My stomach sank as I realized I'd be learning on the fly. I buttoned my brand-new white coat and made sure I had my stethoscope.

I got to the room. Mercifully, the family had gone home for the night and there were just 2 nurses straightening things up.

The ex-patient's eyes were wide open. He stared straight ahead, pining for the fjords.

Trying to look like I knew what I was doing, I strode confidently over to the bed... then stopped as I realized I had no idea where to start.

Finally, I waved my hand in front of his eyes.

He didn't blink.

The nurses began laughing. I began sweating.

Realizing I was hopelessly lost, and blanking, one took pity on me and suggested checking his pulse and perhaps use my stethoscope. At that point I began remembering things like vital signs (or the absence thereof) and other basic proof/disproof of life.

 

"He's dead, um, what's your name?"

I lay in my call room the rest of the night, waiting for a page from the morgue that the guy had woken up and was wondering what kind of idiot had pronounced him dead.

Sunday morning, 12:37 a.m.

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

Mr. Phone: "Yeah, I see Dr. Nerve for my headaches, and when I had one last month he called in some Migroblast, and it was really effective. Do you know if he'll call it in next time I have a headache?"

Dr. Grumpy: "Are you having a headache, sir?"

Mr. Phone: "No, I'm fine, I haven't had one since then. I only get a few each year. But if I have one, will he call in the Migroblast again?"

Dr. Grumpy: "Why don't you call his office on Monday and ask?"

Mr. Phone: "Oh, I guess I can do that. Hey, have a good night!"

Genetics

Mrs. Worry: "I'm concerned about Alzheimer's Disease, because I have a family history of it."

Dr. Grumpy: "Who had it?"

Mrs. Worry: "My ex-husband."

Mary's desk

Mr. Stand: "Hello?"

Mary: "Hi, this is Mary at..."

Mr. Stand: "Um, are you the girl I met last Saturday at Pick-Up Charlie's? Hey, the reason I haven't called yet is because..."

Mary: "Uh, no, I work at Dr. Grumpy's."

Mr. Stand: "I don't remember a bar called Dr. Grumpy's. Where is it? I must have been blitzed. Anyway, I'm glad you called because..."

Mary: "Dr. Grumpy is a neurologist. You have an appointment here at 10:00 tomorrow morning. I'm calling to remind you of that."

Mr. Stand: "Wait, you work at my neurologist's AND you came home with me from Pick-Up Charlie's last weekend?"

Mary: "No. I work here. I'm married. I've never been to Pick-Up Charlie's."

Mr. Stand: "Oh... This is awkward... I guess I'll see you tomorrow at 10:00, then."

100 years to the day

This picture was taken 100 years ago today, off New York City. It's the U.S.S. Arizona, shortly after completing engine repairs and only 6 months after she was commissioned into the navy. 3 days after this picture was taken the United States entered World War I.

At the time she was the biggest, newest, and most advanced battleship in the world. And home to 2,290 young men.

This is the same ship today, after the beginning of another war. 1,177 young men are still aboard her.

Check, please

This weekend Craig is hosting a murder-mystery party for his friends, with crimes he's writing himself.

Last night we stopped for a bite on the way home from band practice. He had a notebook, and was frantically writing down ideas for the party mysteries.

At one point he said "One more to go. I JUST NEED INSPIRATION FOR ONE MORE MURDER!!!"

Saying that loudly gets you some interesting looks in a crowded diner.

Publishing

Dear Cureus,

Thank you for your recent email.

I must say, I'm delighted that you enjoyed my article "," which was published in , . I spent years working on it, as a much-anticipated follow-up study to "?" and ".", which you may have seen in / and ;, respectively.

I'm impressed that your "new and unique" article rating system felt "," was so important. I'd been concerned, as several colleagues were less flattering, comparing it to something one might see produced by a :

Please keep an eye out for my "!" which will be featured in next month's issue of " as the centerfold.

Yours truly,

Ibee Grumpy, M.D.






- Thank you, SMOD!

Osteichthyes

Mrs. Gourami: "What's your fish's name?"

Dr. Grumpy: "Ed."

Mrs. Gourami: "And he just stays over there?"

Dr. Grumpy: "Yep."

Mrs. Gourami: "That really bothers me. I mean, for him to be in there all the time. You'd think he'd want you to take him out of the water for a walk or something."

Dr. Grumpy: "Uh..."

Mrs. Gourami: "It just doesn't seem fair to me, like animal cruelty."

On the road again

Taking a week off for the kids Spring Break. See you next week!

"Don't eat or drink out of it, either."

Seen in a hospital bathroom:

Thank you, Rachel!

Parenting

Last night was the twins' indoor marching band show, combined with a school dance recital.

We took my Grumpymobile (a used 2007 Toyota Highlander, recently bought to replace the 1999 Nissan Maxima which had died). Frank also went, since he does lighting for the auditorium.

After the show there were 3 girls and 2 boys chatting with the twins. I let them talk for a few minutes, but after a while I wanted to go home, and went over to break it up.

Apparently, they’d been waiting on ME. Without bothering to check with, say, ME OR MRS. GRUMPY, Craig had previously promised these kids rides home. Since their parents had been told they didn’t need to come get them, they’d made other plans. And it was too late, dark, and cold to walk.

So we were 10 people in a car that holds 5, max.

It ended up as 3 in front (one on my wife's lap), 4 crammed in the back seat, and 3 shoved in the hatchback cargo area in back. It was snowing. The windows were fogged from 10 sets of respirations. Off we went, with my phone giving us directions to their homes.

Marie is taking driving lessons, and has memorized the entire book of state driving laws. So she points out any traffic violations she sees, loudly.

When someone made a turn in front of us without using their signal, she rolled down her window (with snow coming in) and shouted “HEY! That’s against the law!”

Craig's yelled from the cargo area: “So is driving around with 3 kids in your trunk!”

Then Frank farted, LOUDLY, and the whole car smelled like a sewer. On top of the body odor of a bunch of teenagers who have just finished marching and dancing for 2 hours under hot stage lights.

I drove the rest of the way with the windows down, and didn’t care if they froze.

At least I know these kids will never ask for a ride with the Grumpys again.