Tuesday Evening, During Desert

Dr. Grumpy: "Dr. Grumpy, returning a call."

Mr. Duh: "Yeah, I was there this afternoon, and you told me to stop taking my Lipitor?"

Dr. Grumpy: "Yes, I did."

Mr. Duh: "And you wrote me a note, I have it here, it says 'Stop taking Lipitor'."

Dr. Grumpy: "Correct."

Mr. Duh: "So, does that mean I should stop taking it? Or just cut the dose in half?"

Dr. Grumpy: "It means you should stop it."

Mr. Duh: "Should I stop just the Lipitor, or should I stop stuff you didn't write down?"

Dr. Grumpy: "Just the Lipitor."

Mr. Duh: "Completely stop the Lipitor, you mean?"

Dr. Grumpy: "Yes."

Mr. Duh: "Okay, thanks for clearing that up, your note was kind of vague."

Averages Aren't Always Helpful

Dr. Grumpy: "At your last visit you were averaging 2 migraines a week, how has that been since starting the new medication?"

Mrs. Analytical: "Better" (whips out PDA) "The first week on it I went to 1.94 migraines, the second week I had 1.89 migraines, and the 3rd week I had 1.85 migraines. Last week, though was worse, and I had 1.91 migraines."

Dr. Grumpy: "How do you figure out these numbers?"

Mrs. Analytical: "I use accounting software."

Dr. Grumpy: "But how is 1.91 migraines different from 2 migraines?"

Mrs. Analytical: "The software says it is."

Not a Good Sign

On today's schedule, my first patient of the day is listed as "Mrs. Ancient, referred for memory loss".

I look in the lobby. She's out there, holding a magazine upside down. And she has her bra on outside her shirt.

Bartender, Gimme a Light

And a big Dr. Grumpy thank you to alert reader Allison, who sent me this.

Mary's Desk, November 23, 2009

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

Ms. Bright: "Yes, I need to make an appointment to see Dr. Grumpy."

Mary: "Okay, let me look... We can see you tomorrow afternoon at 4:00?"

Ms. Bright: "Oh, that won't work. How about at 5:00?"

Mary: "Sorry, that's when we close. Would earlier in the day be better?"

Ms. Bright: "No, I can only come in at 5:00 in the afternoon on any weekday."

Mary: "I'm sorry, our last slot of the day starts at 4:00."

Ms. Bright: "Okay, but if someone who has a 5:00 appointment cancels, can you call me?"

Sunday Night, 11:25 p.m.

Snowball is a mutt with a lot of curly white fur. Our vet thinks he's a LhasaPoo.

In the last few months the fur has overgrown his eyes, so that we can't see them. This doesn't appear to be a problem for him, as watching him navigate the house it's obvious that he sees quite well.

Marie, however, has serious issues with this. She's convinced he's now blind, in spite of all evidence to the contrary.

So last night we were woken by wild howling and barking. The hall bathroom light was on, so I ran in there.

Marie apparently was unable to sleep, and was up worrying about Snowball's vision. She REALLY felt something had to be done, so she'd cornered him in the bathroom, and was using all sorts of her own hair things to pull the hair out of his eyes. She had his bangs tied up in ponytails over each eye. She also had plastic hair clips placed above and below both eyes to hold more hair out of the way.

It was so sad. He looked like the guy in "A Clockwork Orange" where they wired his eyes open to force him to watch movies.




I sent Marie to bed and freed Snowball. He spent the rest of the night in bed with me to show his appreciation.

Between my kids and my cell phone I'm getting pretty damn sleep deprived. Maybe my dementia patients today won't notice if I nap in front of them.

Sunday Reading

Sitting in the hot tub this afternoon, trying to catch up on my neurology reading. I learned that:

1. People with lots of stress tend to have problems sleeping (paper presented at the 23rd annual meeting of Associated Professional Sleep Societies, source- Neurology Reviews, September, 2009, page 15).

2. Pilots who fly routes of more than 16 hours in length who take naps during the flights (these flights are mandated to carry 4 pilots) have a lower incidence of fatigue than pilots who don't take naps during similarly long flights (paper presented at the 23rd annual meeting of Associated Professional Sleep Societies, source- Neurology Reviews, August, 2009, page 5).

Since both of these papers were presented at the same meeting, I have to wonder if the audience slept through the results. And it was held in Seattle, the coffee capital of North America, too.

Death and Money

Since we seem to be in an ethics mood following that last post, let me put up this one up. It's a case that's bothered me for over 15 years. I know this is a change from my usual bitchy humor, but what the hell.

Let's take the Way-Back machine to the early 1990's. Dr. Grumpy is a 3rd year medical student, doing a 6-week surgical rotation at a VA Hospital in the heartland. Please remember, I am at the level of a peon (or lower) and therefore have no input in the case.

Patient is a 75 year old man, who, to use a medical term, is sick as shit. Multiorgan disease. Metastatic cancer. Sepsis. On dialysis. He has gigantic bedsores down to muscle and bone on his back and butt (this is why surgery was involved, to debride these horrifying things). He's suffering terribly. He's had a stroke, and can't talk or understand speech.

He has a wife, 20 years younger than him, who he married 2 months earlier, when he was still ambulatory. She is the POA. I know nothing about how long she'd known him previously. If he had kids, I don't remember, and I never saw any.

This poor man needs to die. That is blunt, but true. He will never have a meaningful quality of life, ever. He is suffering, and we can do nothing to really comfort him. We can't give him Morphine for his pain, because that might shut down his breathing and make him die because...

He has a large life insurance policy, the details of which I don't remember. BUT I do remember one thing very clearly, because it was a big topic of discussion. The wife ONLY gets the money IF the patient dies after June 1. If he dies before, she gets nothing. Maybe his unknown kids would get it before then, I just don't know. Please remember this was over 15 years ago, and I don't remember a lot of the details.

So it's now February 24. Over 3 months left until the wife can collect money. And the patient is a full code. He codes at least once every 2-3 weeks. Each time the medicine team runs in, shocks him, forces him to stay alive. Forces us to continue cleaning these horrible gaping wounds down to the bone. And, from a financial viewpoint, his care is likely costing $5,000 to $10,000 of your tax dollars per day.

And the wife won't let him go. She maintains that she loves him and can't live without him, and can't bear to let him die. Maybe that's true. Or maybe not...

I don't know how the story ends. I went off rotation, and to another hospital, at the beginning of April.

Sorry to be a downer, but I thought it would be interesting to toss out an ethics case after the responses to last night's post.

I Ain't Coming

I can always use money. Regardless of what the public seems to think, doctors are generally not phenomenally wealthy.

So I hate turning business away. But tonight I refused a hospital consult. Why would I do that?

Because.

The consult was for an 88 year old lady with advanced Alzheimer's Disease. Her sad life was reduced to lying in bed staring at the ceiling.

The patient had been seen by 2 other neurologists during this admission, and 3 others in the year previously. All had told the family the same sad facts of the case.

Yet, the family called me last night for a 6th opinion. A granddaughter poured out this sad story to me, and begged me to come see Grandma.

I asked her exactly why she wanted me to come in, since it didn't sound like I had much to add. Grandma has already had every test in the book.

So granddaughter said "Because the other neurologists just keep giving us bad news, and tell us to call hospice. We're looking for someone who will tell us this can be reversed, and who can fix her."

And that's why I turned down the consult. Because I'm not going to be a party to this insanity just to collect $100 from Medicare. It's not fair to anyone, especially Grandma. I bet she'd be horrified if she knew what was being done.

This is sad. But I won't be part of this family's denial issues. Me telling them the bad news for a 6th time obviously isn't going to change their actions. They'll just keep looking for someone who is either incompetent or willing to lie.

And that's why I turned it down. Because I respect Grandma. I'll never know who she was, but I doubt she'd want more docs being a part of her family's inability to let her life go with dignity.

Random Saturday Moments

Random moment #1

We took the kids to a sporting event today. After a while Mrs. Grumpy sent me to get drinks and nachos.

So I'm standing in line at the counter, with one guy ahead of me, buying a hot dog. I overheard this:

Mr. Hotdogbuyer: "It's $5.95 for THAT dinky hot dog! Geez, my dick is bigger than that!"

Counter girl: "I certainly hope so, sir."



Random moment #2

We stopped at Target to get assorted junk. Up in front they had various holiday gift sets. One of them was a "sampler set" in a green and red box with snowflakes on it.

What was it a bunch of samples of? Beer? Chocolates? Coffee?

Nope. Deodorant. Had 5-7 things of deodorant, different brands and scents. I swear.

If someone gave that to you, what would you think?

We're Not There Yet

Mrs. Technophobe, I understand that this "internet" and "email" thing look kind of magical, as you only sent your first email last week, with your granddaughter's help.

And I appreciate you telling me that you can look up movie show times online. I tried my best to look impressed. I didn't have the heart to tell you that you may be the last person in a G8 country to find this out.

And you're clearly fascinated by the fact that I can send your prescriptions in by email. Obviously, being a net newbie, you haven't read posts by myself or The Angry Pharmacist bitching about how much we HATE e-Scripts.

But, as much as you apparently think this is going to happen (because in your mind what else could "e-prescription" mean), your pills ARE NOT going to come to you by email. I swear. The matter-to-energy-to-matter conversion technology isn't there yet. And arguing with me and Annie about this is not going to make it happen.

Keep an eye on your mailbox. The metal one, yes, that thing, in the front yard, and your Plavix will magically appear there in about a week.

You Idiot

Dr. Grumpy: "At your last visit I started you on Neurontin for the pain. How's it working?"

Mr. Idiot: "It works fine, but I don't like the side effects."

Dr. Grumpy: "What kind of side effects are you having?"

Mr. Idiot: "If I stop taking it, the pain comes back."

Progress Note Addendum

William, a medical student, has submitted the following, more detailed, chart for your perusal.

I still think we neurologists should have a special "Freaks and Greeks" heading for our field, though.

Thank you, William!

(click to enlarge)

Why Did You Decide To Become a Neurologist?

I get that question a lot, people wondering why I'm a doctor, how I got into neurology, if this is my real hair or just a cheap rug, and... but I digress.

Anyway, I'd like to present this flow chart which explains the complex process by which a medical student (sort of like a stem cell) eventually transforms into their specific field. It was sent to me by an anonymous reader, so thank you whoever you are.

You'll notice neurology isn't listed here, likely due to space constraints. I'd put it somewhere under internal medicine, with a special "Freaks and Geeks" section leading to my field.

(click to enlarge)

Turkee and Grayvie! Yum!

Alright, my kids school district sent a flyer home with them tonight.

They're having a Thanksgiving lunch next week, and are inviting parents to join their kids at it. The flyer included the following:


"Please join you child during they're regular lunch schedule"

"Includes choice of desert" (Sonoran? Sahara? Gobi?)

"Sliced turkey brest"

Holy Electric Boner Batman!

The Science Marches on Department has brought the following medical research breakthrough to my attention:


Penile Shockwave Therapy Shows Promise For Erectile Dysfunction

Thursday Morning 2:48 a.m.

Today's Quiz

I (and most of my neighborhood) were blasted out of bed this morning.

I was woken by:

A. Phone call from a deranged patient.

B. Phone call from a frantic ER doc.

C. Phone call from a bored nurse.

D. My 8-year-old son Craig, who for whatever reason thought it would be funny to turn on his CD player in the middle of the night, playing "YMCA" at full volume.

(If you guessed "D", congratulations! And I had no idea Mrs. Grumpy and the neighbors even read this).

It's fun to stay at the...

That's The Way It Is

My esteemed colleague ERP put this up today, and I thought it was worth sharing.

Family Math Issues

Mrs. Hyper: "I have 3 kids."

Dr. Grumpy: "That's nice. Boys? Girls?"

Mrs. Hyper: "One of each."

Dear Mr. Attorney,

I appreciate you sending payment for Mrs. Jones' medical records.

As you know, her chart was quite large, so printing it up took quite a bit of time and paper. You also wanted me to have it notarized, so I had to drag it down to Local Bank and wait in line.

Then postage was a fortune, since you wanted it sent certified.

Anyway, because it took some time and effort, I enclosed a cover letter asking for $50 payment. Your office manager was kind enough to send me a check for $50 last month to cover this, on the same day she received the packet.

So it was quite a surprise to get a personal note from you yesterday, saying that you felt the $50 was excessive. You did some calculations in your letter, and said that (based on state law) you only owed me $27.45, instead of the $50 I'd previously asked for (and received).

But it was still nice of you to send a check for $27.45 attached to your letter, paying me what you thought was "reasonable, and more than fair" for Mrs. Jones' records.

I've deposited both checks, and thank you and your law firm for having paid me a total of $77.45 for a chart I'd only asked $50 for in the first place. Extra money around the holidays is always nice.

Yours truly,

Ibee Grumpy, M.D.

Packing Overkill

One of the things that drives me nuts is shipping stuff. Not mailing stuff out, though that can be a pain, but more the way stuff gets sent to me in containers that are insanely out of proportion.

Lets take Axert. This is a migraine drug that has no drug reps. So when I need samples I have to call them, asking them to ship me some.

Last week I called for samples, and they showed up today. It comes in a blue and yellow package with 4 little tablet packages in it. But it always ships in a freaking HUGE box, surrounded by a crapload of paper, like 2-5 trees worth.

So here's a picture of the entire Axert package and the box it was shipped in. I put a Diet Coke in the picture to give you some idea of size.




Of course, the Axert people aren't the only ones guilty of this insanity. I have a patient coming in for Botox injections later this week, so I ordered a bottle. ONE dinky bottle (which is freaking $560, too). Now, I understand Botox has to be kept cold during overnight shipping, and needs some styrofoam and ice, but even still the shipping seems to be a little excessive. So here, for your perusal, is a bottle of Botox, the box it came in, and another Diet Coke.





So, now you know how many trees it takes to ship a package of Axert or bottle of Botox.

Crap! That Hurts!

Purell- It isn't just a great hand sanitizer anymore.

It also does a fucking AWESOME job of letting you know where every single damn cut & skin crack is on your hands.

Tuesday Morning, 1:58 a.m.

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

Mr. Sleepless: "Hi, I take Compazine for nausea, and wanted to know if it's safe to take with my epilepsy?"

Dr. Grumpy: "Haven't you taken it as needed for several years? It's never caused you to have a seizure before, has it?"

Mr. Sleepless: "No, never had a problem before, and I've been using it here and there since the mid-90's"

Dr. Grumpy: "Then it shouldn't be a problem."

Mr. Sleepless: "Oh good. Sorry to bother you, but I couldn't sleep, so I started googling all my medicines, and saw that Compazine could do this."

Um, Okay...

Mr. Hedhurtz: "I had a horrible migraine this weekend. Worst I've had in years. It was so bad I was thinking of going to the emergency room."

Dr. Grumpy: "Did you?"

Mr. Hedhurtz: "No, I went to the casino instead."

Damnit, Jim, I'm a Doctor, Not an Electrician

I finally had the time today to fire up the Grumpy family hot tub for the winter.

So I cleaned it out, filled it up, added chemicals, put in a new filter, etc.

For whatever reason, though, I couldn't find the power cord that comes with it. Because I'm a guy (and therefore inherently stupid) I just grabbed an extension cord out of the garage. Mrs. Grumpy kept telling me I wasn't supposed to do that, because the special hot tub cord had extra circuits or fuses or breakers or whatever in it, and you couldn't use something else.

But I wanted to get the hot tub going, so I told her it would be fine, and hooked it up.

The kids were excited, so I had them out in the yard with me. They counted down from 10 for me to flip the switch, turning it on for the winter.

"5-4-3-2-1- HOT TUB!". I pressed the button. The jets whirled, the water swirled, the kids laughed.

For about 5 seconds.

Then there was a loud "POP!"

And the hot tub turned off.

And the kids stopped laughing.

And all the lights in the house went out.

Another 5-10 seconds of absolute silence went by, finally broken by Mrs. Grumpy saying "You bozo."

She went around to futz with the switch box. She found the correct power cord in the garage. And I am in trouble.

Sunday Reading

Catching up on some reading today and found:

A study on patients with bleeding into the brain, which found that patients with only 1 type of brain hemorrhage had a better prognosis than patients with 2 types of brain hemorrhages.

Really. I'm not making this up. Archives of Neurology, January 2009, page 79.

Suckered In

This summary is not available. Please click here to view the post.

The Germ Theory and Netflix

Okay, one of my alert readers has brought a, um, interesting website to my attention.

We all know about Netflix. You rent a movie, they mail it to you, you keep it until you watch it (or realize you'll never get around to watching it), mail it back, and then get another movie.

Well...

There is (I swear I am not making this up) a sex toy business based on the same idea. It's called Rent-A-Dildo.com

Basically, you pay $19 a month. You pick out whatever sex toy floats your boat. Use it to your heart's (or whatever) content. And then send it back and request another. You can have one sex toy out at a time unless you join their premium service (called the "Golden Dildo Plan", I swear to God!).

The site even says "Each toy is tested for quality and performance before it is added to our collection." Unfortunately, it doesn't show you a picture of the tester ("Hey Pa, see if the cow likes this one!"). If you party hard you can also pay for the "extra batteries" option.

So the sex toy that you've had up in your body parts gets sent to someone else, and you get to use a sex toy that's been up in somebody (or something) else's naughty bits.

It's been roughly 150 years since Louis Pasteur and Robert Koch proved the germ theory of disease pretty conclusively, but hey, I suppose it could still be wrong. Maybe STD's are just from bad humors and demons, like the ancients believe.

But fear not! The site says "We've developed a patent-pending process for thoroughly cleaning each toy before it is sent out to a customer." I mean, they certainly could be doing something pretty advanced (anything less would be bad for business), but details aren't listed. For all you know they could just be soaking them overnight in a kiddie pool filled with water and bleach. Or running them through a dishwasher. Or wiping them off with a paper towel and doing a quick sniff test. Or maybe the "patent-pending process" involves somebody else's fetish.

I wonder if they have a recommendations feature, like Netflix or Amazon?: "Since you previously enjoyed the 'Black Mamba Rabbit' you may want to try the 'Rabid Jungle Rhino'."

Are future product lines going to include rent-a-toothbrush, rent-a-condom, and rent-a-tampon?

The site also features this notice , which Dr. Grumpy doesn't have the nerve to put up here in it's entirety.

Caveat emptor.

Now THIS is a Christmas Tree Ornament

Granted, it would be cheaper to just make your own with string and a paperclip.

(click to enlarge)



And a big Dr. Grumpy thank you to alert reader EE, who submitted this.

Say WHAT?

I'm reading through hospital records on a patient who's coming in later today. They include a consult note from another local neurologist, which contained this statement:


"This patient's confusion is from a multifactorial toxic-metabolic encephalopathy. This is primarily caused by, but not limited to, multifactorial causes from multifactorial medical issues, multifactorial medications, and other multiple multifactorial factors. Multifactorial treatments focused on addressing these multiple multifactorial issues may or may not result in a polyfactorial and/or multifactorial improvement in his multifactorial toxic-metabolic encephalopathy."

Tactful Invitations

Gotta love these charity ball things.

Beware of the Staff

You piss off my office crew at your own risk!

Lunch today was from a new drug rep, pushing a sleeping pill.

She made the MAJOR mistake of rudely talking down to my staff, letting them know they are peons, and that she only deals with doctors. This pisses me off, and even worse, it pisses them off.

Anyway, her sleeping pill's claim to fame is that patients who take it get an average of 7.8 hours of sleep. As a result, they have little pamphlets with this fact, and the rep had a big button on her jacket that said "Are your patients getting 7.8 hours every night?"

During lunch she left her jacket over the back of a chair outside our break room. While she was talking I noticed 2 of the girls disappear for a few minutes.

When Ms. Drugrep was leaving she put her jacket back on, and brought me a pad to sign for samples. As I scribbled I noticed that the button on her jacket had been altered, and now said "Are your patients getting 7.8 inches every night?"

She has no clue, either. And I'll likely never find out what happens.

Thursday Morning, 2:23 a.m.

My cell phone chimes. It's the hospital.

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

Nurse Wurse: "Hi, I'm calling about Mr. McAclot, the gentleman in room 742."

Dr. Grumpy: "Umm, I'm not..."

Nurse Wurse: "He had a stroke yesterday, and because he's been getting worse Dr. Hospitalist ordered a repeat head CT tonight that..."

Dr. Grumpy: "Hang on, I..."

Nurse Wurse: "Doctor, will you PLEASE let me finish! This is urgent! His CT showed a large bleed, which is new. Dr. Hospitalist told me to call neurology for further orders."

Dr. Grumpy: "He's not my patient."

Nurse Wurse: "Well he's somebody's patient. I mean, there's a note in the chart from a neurologist from yesterday."

Dr. Grumpy: "Why didn't you call that neurologist?"

Nurse Wurse: "I can't read their handwriting, and... LOOK! I'M JUST FOLLOWING DR. HOSPITALIST'S ORDERS! HE TOLD ME TO CALL NEUROLOGY, AND I DID! YOU WERE THE FIRST NEUROLOGIST LISTED IN THE STAFF DIRECTORY!"

Dr. Grumpy: "But I'm not the neurologist taking care of this patient!"

Nurse Wurse: "What does that have to do with it?"

Attention Female Office Staff

Look, we've shared the same bathroom for 10 years. I've been scrupulously careful to observe the male-female bathroom etiquette. I mean, you guys know where I work and live, and would kill me if I didn't.

And I have no problem with you bringing in your 6 year old son today because he has a cold, and daycare wouldn't take him. That happens to all of us.

HOWEVER

When a new male is introduced to the office (i.e. Mr. Sniffles) and suddenly someone is leaving the seat up, missing his mark, and peeing all over the toilet rim, DO NOT COME BLAME IT ON GOOD OLD DR. GRUMPY. His aim and attention to detail have been proven over 10 years of sterling toilet-rule devotion to his office staff. So you will need to look for other suspects with Y chromosomes.

Thank you.

Playing Stupid. And Winning.

I share space with another doc, (we aren't even in the same specialty). We each have our own sign-in sheets, about 3 feet from each other, with our names and specialties at the tops in BIG BRIGHT LETTERS.

In spite of this, patients routinely sign in on the wrong sheet. Or (even worse) just stand at the front counter with a blank, cow-eyed expression, as if figuring out which sign-in sheet to use is advanced calculus.

So this morning I'm up front looking at some reports, and one of these cow-eye-people comes in, and just stands there. So Mary goes over to help.

Mary: "Hello! Are you here to see Dr. Grumpy or Dr. Pissy?"

Cow-person: "Yes".

The VFW Visits

In honor of Veteran's Day, I'm re-running this post. It was originally put up in December, 2008, but seemed like an appropriate one for Veteran's Day.

Bill is a pleasant 90 year-old fellow who's blind in one eye and has severely impaired vision in the other. He's also mildly demented.

Because of the vision and cognitive issues, I sent him for a driving evaluation last month, which he failed miserably. So he lost his license.

So today he had a follow-up appointment. He came to my office (which is pretty small) with a bunch of friends from the VFW (like 8-10 of them). All were well over 80 and were wearing their VFW hats. All came to give me glowing testimonials as to what a wonderful driver Bill is (I suspect he's the chauffeur for the group).

My favorite line: "Doc, Bill drove a tank all over Germany. He's perfectly safe".

Mary's Desk, November 10, 2009

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

Mr. Veefdubya: "I need to make an appointment to see the doctor."

Mary: "Okay, we can see you tomorrow, or..."

Mr. Veefdubya: "WHAT? YOU'RE OPEN ON VETERAN'S DAY?!!!"

Mary: "Um, yes, sir."

Mr. Veefdubya: "That's unbelievable! And disrespectful! And rude!"

Mary: "I'm sorry, sir, we..."

Mr. Veefdubya: "It's a national holiday! You should be at a parade! Or cemetery! Or a nursing home! You should be honoring and thanking the veterans who sacrificed for our freedom! I'm a veteran, and I'm personally offended that you're open on Wednesday!"

Mary: "I'm sorry, sir, and thank you for serving. Would you like to come in Thursday instead?"

Mr. Veefdubya: "No, tomorrow is fine. I don't have anything else planned. What time should I be there?"

November 10, 1975

The legend lives on from the Chippewa on down
Of the big lake they call Gitche Gumee
The lake, it is said, never gives up her dead
When the skies of November turn gloomy.

With a load of iron ore, 26,000 tons more
Than the Edmund Fitzgerald weighed empty
That good ship and crew was a bone to be chewed
When the gales of November came early

The ship was the pride of the American side
Coming back from some mill in Wisconsin
As the big freighters go it was bigger than most
With a crew and the captain well seasoned.

Concluding some terms with a couple steel firms
When they left fully loaded for Cleveland
And later that night when the ship's bell rang
Could it be the North Wind they'd been feeling?

The wind in the wires made a tattletale sound
And a wave broke over the railing
And every man knew, as the captain did, too,
T'was the witch of November come stealing.

The dawn came late and the breakfast had to wait
When the gales of November came slashing
When afternoon came it was freezing rain
In the face of a hurricane west wind

When supper time came the old cook came on deck
Saying fellas it's too rough to feed ya
At 7 PM a main hatchway caved in
He said fellas it's been good to know ya.

The captain wired in he had water coming in
And the good ship and crew were in peril
And later that night when his lights went out of sight
Came the wreck of the Edmund Fitzgerald.

Does anyone know where the love of God goes
When the waves turn the minutes to hours?
The searchers all say they'd have made Whitefish Bay
If they'd put fifteen more miles behind her.

They might have split up or they might have capsized
They may have broke deep and took water
And all that remains is the faces and the names
Of the wives and the sons and the daughters.

Lake Huron rolls, Superior sings
In the rooms of her ice water mansion
Old Michigan steams like a young man's dreams,
The islands and bays are for sportsmen.

And farther below Lake Ontario
Takes in what Lake Erie can send her
And the iron boats go, as the mariners all know,
With the gales of November remembered.

In a musty old hall in Detroit they prayed
In the Maritime Sailors' Cathedral
The church bell chimed, 'til it rang 29 times
For each man on the Edmund Fitzgerald.

The legend lives on from the Chippewa on down
Of the big lake they call Gitche Gumee
Superior, it's said, never gives up her dead
When the gales of November come early.

- Gordon Lightfoot.

Although often overlooked in the story of the Edmund Fitzgerald, the crews of the freighters Arthur M. Anderson and William Clay Ford should be remembered, too. They were the closest ships when the Fitzgerald sank, and went back to look for survivors (there were none) in spite of the fact that the severe storm which had just sunk the Fitzgerald could have sent them to the same fate. The Anderson still sails the great lakes today, 57 years since she was launched and 34 years since the wreck of the Fitzgerald in the November, 1975 gale.

Whatever

Mrs. Snot: "The sinus doctor said I have inflamed tornadoes in my nose."

Dr. Grumpy: "You mean inflamed turbinates?"

Mrs. Snot: "Yeah, whatever."

Pretty Colors

Mrs. Freek, I'm so glad Cymbalta at 60mg each day has helped your symptoms.

I'm sorry I don't seem very sympathetic in refusing to write a letter to your insurance company about the drug. Honestly, this stuff ain't cheap, and you should appreciate that your company is willing to cover it for you at all.

The 30mg and 60mg pills cost about the same per pill. So taking two of the 30mg each night, instead of one 60mg, basically doubles the price. And I really don't have a good reason to tell your insurance that they should pay the higher cost.

There might be medical reasons SOME people need this, but "because I like the cute blue & white 30mg, and not the ugly blue & green 60mg" is not one of them.

I also appreciate that blue & white are the colors of your alma mater, but again, I don't think your insurance company is going to feel that justifies them paying twice as much for your pills.

And for once I agree with them.

Idiocy in America

During a break in call yesterday I went to the doctor's lounge to get a sandwich and Diet Coke.

While eating I watched a few minutes of a football game. There was a silly beer commercial during it, which featured a lady attaching a flower to her husband's lapel with a nail gun.

But what REALLY scared me was that at the bottom of the screen it said "Do not attempt this yourself".

No shit. And you needed to tell us that.

On the other hand, after thinking about some of my patients, it's probably not a bad idea to put that warning up.

Dear Dr. Hummingbird,

What on Earth is your reasoning to take hospital call when you don't want to take care of patients?

I can only assume it's money. Our local community is well aware of your lack of competency, and I don't know anyone who refers to you.

I'm the neurologist on call this weekend, and you ordered 10-15 consults for me, some of which made sense, and some of which were bullshit which defied even the normal boundaries of defensive medicine.

What REALLY chaps my hiney, though, is your uncaring stupidity. Let's review some of the conversations I had with nurses this weekend.


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

Nurse X: "Yeah, you saw Mrs. Jones this morning, the old lady who can't walk? Dr. Hummingbird told me to call you. She wants to discharge her home if it's okay with you."

Dr. Grumpy: "Is she any better?"

Nurse X: "No she still can't walk. But Dr. Hummingbird said she can lie in bed at home, too."


OR


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

Nurse Y: "Yeah, you saw Mr. Smith this morning, the man who came in with a TIA? Dr. Hummingbird told me to call you. She wants to discharge him home if it's okay with you."

Dr. Grumpy: "What did his tests show?"

Nurse Y: "He hasn't had any of them yet. Dr. Hummingbird said that since they may not get done until later today, that we should just send him home now because she's got a barbecue to go to this afternoon, and won't be here to write discharge orders."


OR


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

Nurse Z: "Yeah, you saw Mrs. Stevens this morning for her left hand pain? She's now having severe stomach pain, and had a stool with a lot of blood in it."

Dr. Grumpy: "Why are you calling me?"

Nurse Z: "Dr. Hummingbird told me to call you. She said that since the patient has a neurological issue with her hand that's she's uncomfortable managing any aspect of her care and that you should deal with whatever comes up".



I have nothing against these nurses. They know you for who you are, too, and are stuck because you ordered them to make these inane calls to me.

I'd like to blame this on your lack of experience, or just having a crappy weekend, but this happens every time I wind up on call with you, and my call partners say similarly flattering things about you. And you've been doing this crap for 8 years now.

Thank you for this interesting consult.

More Junkie Logic

Just a weekend of remarkable quotes. I couldn't make this stuff up if I tried.


"I was on my way to my girlfriend's place and did some meth in the car because if I waited till I got there she and her roommate might use it all. But there was something wrong with it and I began shaking, and got real dizzy, and then began puking all over the steering wheel. Then my vision got blurry and I couldn't see the road very well, and I was afraid to pull over cause then a cop might come try to help me, and I'd be in deep shit, so to be safe I started driving as fast as I could to get to the nearest emergency room."

Not Helpful, Either

From a lady I'm seeing at the hospital today, trying to get a list of what she's taking:

"I take that store-brand medicine. It's for a runny nose, or cough, or allergies, something like that. You know what I mean, all the stores have it."

On Call, With Junkies

"I got paid yesterday, so I thought I'd do some crack. I couldn't find my regular dealer, and I called, like, every number I had. Anyway, one of the guys I work with at BK had a friend who knew a dealer, and got me the number, so I bought some from her. But it made me all sick and shit, and that's why I ended up here. It was some seriously bad shit, and wasn't safe at all to be selling it, and that bitch should have known better. That's the whole problem with the world today. My regular dealer has a lot of integrity, but this bitch who I bought it from, I mean, it's just fucked up because a lot of people are getting into drug dealing today just for the money, and don't give a shit about customers like me. And that's just wrong."

Trying Not to Laugh

Mrs. Daughter: "Dad, did you forget to wear your hearing aids today?"

Mr. Olde: "What?"

Not Helpful

Dr. Grumpy: "Let me get an MRI form... Do you have metal anywhere in your body?"

Mr. Irrelevant: "Nope. My wife does, though. She has a pacemaker. And my oldest daughter has an artificial hip. And my brother has a bullet from Korea in one arm. And..."

I'll Leave Things As They Are, Thanks

We get these junk faxes advertising great prices on medical supplies, office equipment, temp help, software, medications, office catering, everything.

So this one came over a few minutes ago from a company called The Physicians Exchange, for a phone answering service.

I think they need to get a better website address.....

(click to enlarge)

Darwin, Halloween, and the Theory of Evolution

The week after Halloween is the ideal time to prove evolution.

Certain species of bugs have developed a really bad taste so predators won't eat them (at least, that's what I've read. I haven't personally done insect taste tests).

Did they actually evolve in that direction? What is the evidence?

Let's look in Dr. Grumpy's break room:


Post Halloween day #1: Everyone brings/dumps their leftover candy at the office. We put it in a big bowl in the break room. We are too damn sick of candy to touch it.

Post Halloween days #2-3: Predators (okay, me and the staff) arrive. The choicest (i.e., chocolate) items disappear first. Reese's PB cups, M&Ms, Milky Way, Snickers, Kit-Kats, Twixt, Butterfingers, Three Musketeers.

Post Halloween days #4-5: Other stuff starts to go. Skittles, Laffy Taffy, Smarties, Starbursts.

Post Halloween days #6 and on: This is when we find the survivors. Just like the unpalatable bugs, some candy types will sit there for quite a while. Candy Corn, Circus Peanuts, Tootsie Rolls, hard suckers, and those horrible taffy things in black and orange wrappers (the latter, I suspect, were only made once in the 1960's and have since just been re-gifted. I think people who got them as kids now give them out as adults, and the cycle continues).


Granted, I have no evidence to suggest that Darwin's staff dumped leftover candy at the office. If they did, however I'd suspect that's more likely to have led him to the theory of evolution than a trip to the Galapagos.

Cause and Effect

From yesterday afternoon:

Mrs. Hedake: "They painted my office building last month, and I just know that's what's causing my migraines."

Dr. Grumpy: "How long have you had migraines?"

Mrs. Hedake: "I've had daily migraines since 1995."

Dr. Grumpy: "Have they changed since the building was painted?"

Mrs. Hedake: "No. Same type as before."

Dr. Grumpy: "Then why do you feel the paint has affected them?"

Mrs. Hedake: "Because I think they'd have gone away if they hadn't painted it."