Christmakuh

(I have no idea who wrote this, or where it started. It gets circulated by email so much I'm sure many of you have seen it. But it's still entertaining)

Subject: Holiday News Release

THE NORTH POLE (Reuters) Continuing the economic trend towards monopolies, it was announced today at a press conference that Christmas and Hanukkah will merge. An industry source said that the deal had been in the works for about 1,300 years.

While details were not available at press time, it is believed that the overhead cost of having 12 days of Christmas and 8 days of Hanukkah was becoming prohibitive for both sides. By combining forces the world will be able to enjoy consistent quality service during the 15 Days of Christmukah, as the new holiday is being called.

Massive layoffs are expected, with lords-a-leaping and maids a-milking being the hardest hit.

As part of the agreement, the letters on the dreidl, currently in Hebrew, will be replaced by Latin, thus becoming unintelligible to a wider audience. Also, instead of translating into "A great miracle happened there," the message on the dreidl will be the more generic "Miraculous stuff happens." In exchange, Jews will be allowed to use Santa Claus and his vast merchandising resources for buying and delivering of their gifts.

One of the sticking points holding up the agreement for at least 300 years was the question of whether Jewish children could leave milk and cookies for Santa after having eaten meat for dinner. A breakthrough came last year, when Oreos were finally declared to be kosher. All sides appeared happy about this development except for Santa's dentist.

A spokesman for Christmakuh, Inc., declined to say whether takeovers of Kwanza, Solstice, or Festivus might not be in the works as well. He pointed out that were it not for their independent existences, the merger between Christmas and Hanukkah might be seen as unfair cornering of the holiday market. Fortunately for all concerned, he said, the other holidays will help to maintain the competitive balance.

He then closed the press conference by leading all present in a rousing rendition of "Oy, Come All Ye Faithful."

More Gift Ideas

Hitting the snooze button too many times? Or are you a 4-wheel drive aficionado that thinks every household appliance should be an all-terrain-vehicle? Or both?

Now, you can truly have it all! An alarm clock that not only wakes you up, but leaps off your night table, forcing you to chase it!

(click to enlarge)





I know this would work at my house, but only once. The alarm might not wake me up, but Blackdog frantically barking at it rolling across the floor would, and then I'd have to get up to clean the puddle where terrified Snowball pissed on the carpet when he thought it was coming to get him. And I wouldn't need to hit the snooze button because in the next minute psycho Cooper would tear it to pieces. And $39.95 seems like a lot of money to me for a 1-time-use appliance.

Suzy Frazzled, M.S.W.

The phones have been ringing busily today, and so a few calls went to voice mail. Annie had me listen to this one. She was laughing so hard she ran to the bathroom so she wouldn't wet herself.

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

Spelling Errrorz

Hot off the fax machine this morning! A bunch of notes on a lady, and referral form that says:

"Send patient to a neurologist ASAP. I think she has a stork."


If it's NOT a spelling error, the patient needs either a vet or an OB.

The First Night

The official Grumpy family Christmakuh tree is up, and I want to wish my Jewish readers a very happy Hanukkah.



For those of you unfamiliar with Tom Lehrer's remarkable work, I suggest you learn more. He is one of the very best musical comedians EVER, with, oddly enough, advanced degrees in science and mathematics. Other brilliant works include The Elements, Pollution, Smut, The Hunting Song, I Hold Your Hand in Mine, and many others. For those who (like me) grew up watching The Electric Company on PBS, he wrote a number of those catchy tunes, such as L-Y and Silent E.

Okay, You Can

Dr. Grumpy: "After you hit your head, how long were you unconscious?"

Mr. Dingdong: "1 minute and 14.37 seconds."

Dr. Grumpy "That's pretty precise."

Mr. Dingdong: "I used a stopwatch".

Attention Junkies!

I hate all of you who have impaired my ability to buy enough Sudafed to keep me and my family snot-free during cold season.

Rot in hell, with a cold. And no medications are available for it. Or Kleenex. You can just chap your nose for all eternity with your shirt sleeves. Or worse.

Dear CVS Caremark,

If your specialty pharmacy mail-order branch is handling my patients' potentially dangerous injectable drugs, it would give me (not to mention them) A LOT more confidence if you knew how to spell your own job title.

(click to enlarge)




Yerz trooly,

Dokter Grumpy.

I Bet He Ain't As Comfortable

Dr. Grumpy: "Is there anything that makes your back pain better?"

Mrs. Lumbar: "Well, my husband has a set of exercise balls, not the huge ones, but the small ones you roll across your muscles, and the pressure from those helps. So I'm able to get comfortable and sleep, but only if I spend the night lying across his balls".

Dear Mr. I.M.A. "Rich" Azzholl, III

I'm sorry about the way things went at your appointment yesterday. I guess you and I just didn't have great chemistry.

I can understand you being frustrated with me. Obviously, a man of your means is used to people kissing his ass constantly. But here at Grumpy Neurology, it doesn't buy you much. Let's face it, Medicare pays me the same amount to put up with you as it pays me to put up with Mr. Nice Butpoor. If you were paying me $1000/hour to listen to your stories about the yacht club I might be more inclined to do so. But I'm only going to get Medicare's flat $115 for you, and my billing company gets 10% of that, and I have to pay Mary, Annie, my rent, the Diet Coke bill, and my malpractice insurance out of the rest.

Anyway, we were obviously off to a bad start when you told Mary that your regular doctor (who you pay cash to) dresses up for you. And this was before you even had a look at me. You also were not happy that, when you asked Mary what kind of refreshments we offer for waiting patients, she pointed to the water cooler.

I SO enjoyed being grilled over my credentials. I really am a doctor, I swear, not some homeless person who decided to rent an office, hire some staff, and buy some cheap office furniture just for the hell of it. You were clearly not impressed that I went through public schooling most of my life. Of course I've heard of your alma mater, but it was so much more fun to watch the horrified expression on your face when I pretended I hadn't, and then asked you if it was in Arkansas. The devil made me do, what else can I say?

I think we reached the low point during the appointment when, after I'd spent 30 minutes taking your windy history, and another 20 minutes examining you, your heavily plasticized wife (who may be putting arsenic in your prunes- watch out) asked me "So when will the doctor come in to talk to us?" That made me feel real special.

So when I heard you tell Mary that you didn't want to schedule a follow-up with me, and wanted to discuss matters with your internist, I knew this translated to "I'm never coming back here and am complaining to my internist about you". And guess what? I don't care.

Be careful the automatic door doesn't hit... oh, sorry, guess I should have warned you sooner.

More Gift Ideas

For those of you still looking for that perfect gift, here's another great idea!

Dogs give you unconditional love, but is that really good enough for you? Wouldn't it be important to know just how many breeds are represented in your mutt? Or is your "purebred" really that? And maybe you'd love your poodle less if you discovered he had a trace of beagle in his lineage?

Wonder no more!

Blood Pressure is Overrated, Anyway

This note was faxed to my office from the patient's family doc this morning.

(click to enlarge)

You Saw It Here First!

My reader Kaitlin notified me yesterday that Dave Barry's column for Sunday, December 6, also featured the nose-shaped soap dispenser that I presented on December 5.

I wish to point out that Dr. Grumpy beat him to press with this important breaking news by several hours, and his column was not leaked to me in advance (unless you consider the catalog being sent to my home to be a leak).

I also am not now, nor have I ever been, Mr. Barry

And I ain't gonna pose in the buff for you guys, either.

Skool Nerse Time

This is Mrs. Grumpy. He didn't want to hear me bitch about my day at the school, and told me to tell you guys. So here.

School nursing brings you an amazing collection of hypochondriacs, and it gets worse with winter break coming and they get restless. So today, besides the usual collection of snotty noses, stomach aches, and "I can't do PE because..." I had this.

Kid #1: "Somethings wrong with my eyes. I can't read the board today."

Me: "Don't you wear glasses?"

Kid#1: "Yeah, but I left them at home."


AND


Kid #2: "I've had this bump on my little finger since I was five, and it looks the same."

Me: "You're ten now. So why are you here?"

Kid#2: "I wanna know what it is."


I also want to thank the 2 teachers (neither of whom was a sub) who sent these kids to my office during regular class time for these complaints.

Whatever

Dr. Grumpy: "Do you have any other medical issues?"

Mrs Barph: "I vomit every afternoon at 3:05 p.m. This started in 1987 and I haven't missed a day since."

I Bet the Cops Love You

Dr. Grumpy: "Sir, why did you call 911?"

Mr. Bozo: "I forgot my doctor's phone number, and thought maybe they would know it, and could call him for me to make an appointment. I need to see him."

More Fun Junkie Quotes

These guys just make a weekend on call so entertaining.


"I've been using crack since I was 18, and I'm 27 now. I mean, that's almost 7 years I've been doing this stuff. I've spent 2 years in jail for it. I've been in and out of every rehab program in town. I've never had a real job, and still live with my parents. It's time for me to turn my life around, and I'm going to start by being honest and telling my parents about my habit. I've been able to hide it from them, but It's time they know I've got a problem."


Dude, if your parents haven't figured that out yet, they're probably on it, too. Also, your math sucks.

Lifestyle Changes

Yesterday I admitted a lady in her 50's who had a stroke. So I'm rounding on her this morning.

Mrs. LDL: "Doctor, I'm changing my whole life right now! I'm going to start being healthy. For many years I've always had a cheese omelet for breakfast. So, today, when they took patient breakfast orders, I realized I had to start doing things differently."

Dr. Grumpy: "Good for you! What did you order?"

Mrs. LDL: "A vegetable omelet, with cheese."

Tis The Catalog Season

With the pentuplet of seasonal holidays approaching (Hanukkah, Festivus, Christmas, Kwanzaa, and Solstice), my home mailbox is full of catalogs selling all kinds of things that these people apparently feel my family and friends can't live without.

Since so many of my patients call my office asking if we have any gift ideas (NO! I HAVE ABSOLUTELY NO FREAKING IDEA WHY THEY CALL ME!!!) I figure many of you are dying to do the same (Dr. Grumpy merchandise is always nice).

So I've personally combed through these many catalogs to help you, my loyal readers, find some of the most useful gifts out there, and will present them over the next few weeks.

Today I'm going to kick off the list with this tasteful item:



Yes, it's a shower soap dispenser (comes with green gel soap! Wow!) that dispenses soap out of it's nostrils. I suppose next year they'll have one that makes a sneezing noise when you squeeze it.

I'd order one for that special coworker who continuously complains about allergies and leaves wadded-up Kleenex all over the office.

Public Service Announcement

Attention ladies:

It is NOT, generally speaking, normal for you to be woken at night by your guy shaking the bed violently, turning blue, and peeing on the sheets. If he does this, and hasn't done it before, he needs medical attention.

You also should not allow this to go on for several nights in a row, and then call his mother to see if she can help you wash all the bedsheets, and (when she asks you why), let her be the one to make the CORRECT decision that he should go to ER.

It is also not cool that you sent him in by himself, so you could stay home and catch up on washing sheets. Your description of the events is usually helpful to those of us in the "med-biz".

Thank you.

Live! From ER! It's Dr. Grumpy!

I'm on call.

While rounding, I was paged overhead to come down to ER for a stroke that had just arrived. Guy who can't move his right side.

So I'm sitting here in ER, watching him from the nurses' station, waiting for my turn to go in. Nurses are hooking him up to stuff, techs in there drawing blood, an EMT going over info with another nurse.

In the middle of this all the patient is lying there, calmly texting with his left hand.

Starting and Ending With a Survey

Well, just as my day began with a strange marketing survey question, apparently it's going to end that way. I'm doing one tonight over the internet, and this question came up:

"When managing a male or female MS patient who wishes to become pregnant, what action do you typically take with their current MS medication?"

You Must Live REALLY Far Away

"I only get migraines when there's a full moon. In my neighborhood I think that's around once a week we have one."

Okay, Let Me Get A Blindfold

I did an online marketing study this morning, in which I was looking at various ad concepts to see which parts of the ads interest, and don't interest, doctors.

So at one point I came to these instructions:

"On the following screen, we'd like to know which parts of the picture did not get your attention. Please click only on those parts of the image that you don't look at."

Homecoming

I pull into the driveway, and walk down to the mail box to get the bills & junk. The neighbor family is out putting up some Christmas lights. Mr. Neighbor comes over to chat for a minute.

Suddenly, my front door flies open. Frank comes out, screaming at the top of his lungs.

Frank: "DAAAAD!!! THE FRONT HALL TOILET BACKED UP ON ME 'CAUSE I USED TOO MUCH PAPER AND NOW THERE'S POOP ON THE FLOOR AND SOME STILL IN THE TOILET AND PAPER EVERYWHERE AND IT SMELLS BAD AND THE TOILET KEEPS RUNNING AND..."

Dr. Grumpy: "Frank, calm down. Why didn't you tell Mom as soon as this happened?"

Frank: "I did. She told me to wait and tell you as soon as you got home."


Mr. Neighbor doubled over laughing. Perhaps for the first time he was glad to have teenagers.

Just Say No

Things are tough all over. Occasionally I get patients asking me if I'll forgive their appointment co-pay. Usually I can't, because most insurance contracts forbid it, and because I'm trying to stay afloat, too.

So today I had a lady tell me she can't afford her $25 visit co-pay, and could I PLEASE write it off? She used the "I need the money more than you do" line.

I know she has legitimate financial hardships, but I refused.

Why?

Do I need the $25 that badly?

I did it because she smokes 2 packs a day. And ADAMANTLY refuses to quit.

Let's look at this:

The average price of a pack of cigarettes in the U.S. right now is $5. This varies by brand & your state taxes, and whether you buy them by the pack or case. But roughly $5 a pack.

So for her, that's $10/day. Or $300/month. Or $3600/year.

I told her that. If she quits smoking, that would be like her getting a $3600 annual raise, without any additional taxes. Ignore the health benefits, just look at the money alone.

All that money for making one life change. That would help her financial situation A LOT. It's a hell of a lot more money than making a $25 co-pay once or twice a year.

She got pissed off and left. Told me that I "don't understand".

She's right. I don't.

For an excellent post on drug co-pays from the pharmacy view, check out this one from The Angry Pharmacist.

Now THAT'S Exciting!!!

From a fax on my machine this morning:


"Our company is looking for males over age 25 who do their own shopping. We're doing a very exciting market research study on the following topic:

PACKAGED SALAD

We think you'll find the discussion to be exciting and enjoyable, and will reimburse you for your time. Please contact us today, as spots will go fast!"

Edgar Allan Poe

Generally, I try not to copy things from other blogs.

But sometimes I MUST make an exception when I see something so good, so clever, that I want to share it and say LOOK AT THIS! IT'S FREAKING AWESOME!!!

And when I do that, I make sure I properly credit it.

Maybe it's because I'm a literature buff, and took too many of those classes in college. Edgar Allan Poe is featured in most of them, and his most famous work is The Raven.

So on reading other blogs today, I found this excellent post written by Maha. She's an ER nurse who writes Call Bells Make Me Nervous. Check her site out. And Maha, please forgive me, but I just had to share your remarkable piece of writing.

So, without further ado, I present Maha's satire on The Raven. It's called The Drunkard.

Had Edgar Allan Poe Been an Emergency Nurse…

The Drunkard

by Maha

Once upon a midnight dreary, while my back ached, weak and weary,
Over many a quaint and curious patient at the triage door.
While I nodded, nearly napping, suddenly there came a tapping,
As of someone rudely rapping, rapping at my triage door.
"'Tis no drunkard," I muttered, "tapping at my triage door--
A well man and nothing more."

Ah, distinctly I remember the bloody night before November,
And each and every staff member had brought a patient to the floor.
Eagerly I wished the morrow, vainly I had sought to borrow,
From my books of assessments thorough –to avoid the cookies from days of yore
And drink my latte from so long before.

But the stinkin’ sad uncertain shuffling of a drunkard’s gait that’s struggling
Thrilled me – filled me with supreme annoyance, never felt before.
So that now to still the beating of my heart, I stood repeating
“Tis no drunkard entreating entrance at my triage door –
Some late UTI-er entreating entrance at my triage door;
This is it, give Toradol galore”.

Towards the patient I finally headed, hope for sleep completely shredded,
“What,” barked I, “please don’t have a complaint I’ll deplore,
But the fact is I was napping and so intently you were tapping,
And so rudely you came slurring, ranting at my triage door”.
And without regard or thinking, he barfed upon my triage door,
Chunky vomit and lots more.

Then, of course, the air grew denser, thanks to the obscene Spencer,
A man now pickled, whose foot-falls dragged in the department’s floor.
“Wretch,” I cried, “why did God bring thee – by the devil he hath sent thee
Respite – respite and Valium please for thy abnormal CIWA score
Why, oh why this loud decree of your drunken presence on my door?!”
Screamed the drunkard, “I barfed some more”.

"Spencer!" said I, "this stench is evil!--Spencer this is the needle’s bevel,
Whether taxi sent, or whether ill-fate tossed thee here ashore,
Desolate, yet all undaunted, in this department un-enchanted,
In this hallway by Horror haunted--tell me truly, I implore--
Is there--is there calm from Gravol?--tell me--tell me, I implore!"
Quoth the drunkard, "I need lots more."

"Spencer!" said I, “more upheavals? - Spencer still, if man or devil!
By the score of twenty and eleven – by the Valium we both adore –
Tell this nurse with sorrow laden, who to call? Perhaps thy maiden?
Please, oh please, I beg thee, use the bucket on the floor.”
Quoth the drunkard, "Nevermore."

"Be that word our sign of parting, man or fiend!" I shrieked, upstarting.
"Get thee out of the department and save my night from being abhorred!
Leave no chunks of vomit as a token for my tolerance thou hast broken!
Leave here with this train token! – Quit the bed and leave the main floor!
Take thy stench as you depart, and take thy form from out the door!”
The drunkard started to loudly snore.

And the drunkard, unremitting, still is snoring, still is snoring
On the pallid stretcher mere inches from the door;
And his socks have all the seeming of a mold that is steaming
And the lamp-light o’er him streaming throws his shadow on the floor;
And my break retreating into shadows that was planned for four,
Shall be taken – nevermore!

How Hard Is This To Understand?

Okay. Your epilepsy has been stable for over 20 years. In fact, I only see you once a year for it, and refill your Tegretol while we chat about sports, weather, whatever.

Your medication dose hasn't changed since the 80's, back before I even went to med school.

I write you a new script once a year, that you fax to your mail-order pharmacy.

Normally I see you in January, but you had to move up your appointment since you'll be out of town next month. So you asked me to date your next Tegretol script for January 1, 2010, and you won't send it in until then. Fine. I did just that.

So, after I've given you a post-dated script DON'T FAX IT TO YOUR FREAKING PHARMACY WITHIN AN HOUR OF LEAVING MY OFFICE!!!

Now I've got the pharmacist calling, wondering if I'm demented and don't know the date (not an unreasonable thought). I'm pretty sure he doesn't think you have some sort of special time-traveling fax machine at home.

So don't do it again. Put the script on your refrigerator and don't cash it in until January 1, 2010 LIKE YOU TOLD ME YOU WOULD and we'll all be happy.

Thank you.

Memories...

The peanut post got me thinking...

When I was doing my internal medicine residency, another doc in my class was a girl named Christine. She was just doing a 1 year internship before going on to radiology.

She was a good person, and a good doc. But she was a HORRIBLE black cloud. Bad luck just followed her and her patients, in spite of the fact that she took damn good care of them.

She just had remarkably shitty luck. When she was on call, her service would always max out with admissions, and they were all really sick. Codes would occur. Her patients seemed to die more often then anyone else's. And, again, this was just bad luck. She was a good doc, just always seemed to get the sickest patients.

After the first 6 months of this, she was so burned out that she needed a vacation, and booked a cruise.

On the first night of her cruise, the guy sitting next to her at dinner collapsed and died from a peanut allergy.

How To Irritate Your Neurologist

Dr. Grumpy: "Any allergies?"

Mr. Cereal: "Nuts... Hey, do you know it's safe for me to eat Honey-Nut Cheerios?"

Dr. Grumpy: "Umm..."

Mr. Cereal: "I mean, I know it says 'nut' in the name, but I wasn't sure if they really have nuts in them, or if they just say that".

Dr. Grumpy: "Have you read the ingredient list on the side of the box?"

Mr. Cereal: "No, why?"


Obviously, I'm allergic to nuts, too, of a sort...

Tuesday Morning Patient Quote

"Sometimes, when I really hurt, I stop breathing. I mean, like, for hours, literally. It hurts so bad I just stop breathing. After my car accident I went 2 weeks without breathing."

This is the Dawning of the Age of Extavia

(I am not a marketing person. I don't have the personality, or the mindset, or the training. So this story only barely makes sense to me. I'm sure the marketing or business people out there will tell me this is perfectly logical).

Extavia!

Isn't that a great name?

I have to wonder how much they paid the person who thought it up. It has a cool ring and the letters "X" and "V" (according to my friends who do sales, these, along with "Z", are considered "power letters", and putting them in words is supposed to connote something impressive).

With a name like that you'd think the drug was new, powerful, groundbreaking.

Extavia! NEW! For Multiple Sclerosis!

Released to the neurology world recently with hoopla, ads, drug rep lunches, etc.

Would you believe that Extavia is over 15 years old, and is being used to launch a drug that isn't even on the market yet?

Here's the story: Betaseron (Beta Interferon 1b) has been on the U.S market since the early 90's. It was the first drug ever approved for MS, and certainly is a decent drug. I prescribe my share of it. It's manufactured by Bayer.

Novartis, another pharmaceutical company, is developing a new MS drug, which it hopes to bring to market in the next 6-18 months.

But Novartis has no MS drug currently out there (though they do have 3 big neurological ones under patent). So they decided that, to get a foot in the MS marketing door now, they should hire a bunch of new reps (though they already have a fairly well-trained neurology sales force), and train them to market MS drugs. This is hard to do when you don't have one.

So they bought a license from Bayer to sell Betaseron, too, to get their reps some practice. But, since they didn't want to market plain old, early-90's Betaseron, they renamed it Extavia! New name! New marketing! Same drug! Same dosing! Same everything except the name (actually, I think the price is slightly lower)!

And, of course, Betaseron is still on the market. In fact, Bayer is making all the Extavia, too. So Bayer is likely going to clean up on the deal, since they get paid regardless of which gets prescribed.

I suspect Novartis will not make money on this, and is using Extavia as a loss leader, hoping to make the money back when the new drug comes out in a year or two.

On the one hand, I think it's good that they're hiring a new sales force to sell Extavia and future drug. Certainly, jobs are good for the economic recovery.

But on the other hand, it still seems kind of silly to me. Like I said, though, I'm not a marketing person.

Cyber Monday- The Deals Continue

For those of you who thought my Wii Fit Plus deal ($19.99 marked down to $19.96) wasn't good enough...

My reader Khym submitted this, even better, Wii deal!

(click to enlarge)



And a great big Dr. Grumpy thank you to Khym!

Thanks, I Didn't Think of That

I sent a patient to physical therapy for his back pain a few weeks ago.

The therapy place sent over a summary note on him just now.

It ended with this line:

"Recommendation: Patient was told not to do things that make his back hurt."

Concerned Parent

I know you're pregnant, ma'am, and I understand your concerns about not wanting to take a medication because it might harm your baby. I don't prescribe pills just for the hell of it, and try to weigh the risks and benefits.

But DON'T tell me that you're worried about the effects of the pills on a fetus when you just told me you smoke a freakin' pack a day, okay?

Cyber Monday Shopping

WOW! These online deals today are great! Look at how much money I can save buying "Wii Fit Plus" today!

What Part of "Closed" Are We Not Getting Here?

Look, people, I know the 4-day Thanksgiving weekend is still in force, but we are on the last day here.

And I don't mind you calling me for legitimate emergencies. It's part of the job, and I signed up for it.

My office message still says "We're closed, please call back during regular office hours for routine matters."

So please stop leaving messages like:

"Hi, are you open today?"

"I thought it was Monday, isn't it?"

"Can someone call me with your phone number?" (DUH! YOU JUST CALLED ME!)

"Is my MRI on Thursday or Friday?"

"Did I miss my appointment 2 weeks ago?"

"Can I find your office on Mapquest?"

"What kind of doctor is Dr. Grumpy?"

"Can I have my driver's license back so I can go Christmas shopping?"


At 8:30 a.m. tomorrow morning the phones will be rolled back, and you can start hassling Mary and Annie for questions about your tests, appointments, insurance authorizations, good shopping deals, safe ways to hang lights, and a myriad of other questions.

Thank you.

In Line at Starbucks

Mrs. Grumpy wanted to stop at Starbucks last night after dinner.


Guy in line: "I can't decide, they all sound good".

Counter girl: "We have the new Caramal Brulee' Latte' you might like. It's really good. Have you ever had creme brulee'?

Guy in line: "No".

Counter girl: "Well, creme brulee' tastes just like the Caramel Brulee' Latte does, um, if you, uh, knew what it tastes like, I mean."


Then I got up there.


Dr. Grumpy: "I'd like a polar bear cookie."

Counter girl: "They're good. We used to have them for other holidays, too, I mean, at least ones where polar bears are part of the theme."

Okay... How many other holidays with polar bears in the theme are there?

Brains and Butchers

This morning I went looking for a decent brain picture for the shirts. I couldn't find anything I liked in Google images, so I dug out and dusted off my old neuroanatomy textbook.

I'd forgotten this line (but it's hard to miss) in the book's first section:

"The fixed brain is serially sliced into 4mm sections on a Hobart Model 410 rotary-blade, electrically-driven, commercial meat slicer."

Think of that next time you're watching your local butcher use one of those things.

This Morning, At The Hospital...

Had to go in to see a patient.

As I got out of my car in the doctor's lot, I passed another doc who was leaving. He had a bumper sticker that said "Driver is medicated for your safety".

It's scary enough to see this on another doc's car. What's even worse is that he's a psychiatrist.

Friday Night, 10:35 p.m.

"Hi, I saw Dr. Grumpy in 2007 or so, and had hurt my neck back then, and physical therapy helped. Anyway, I hurt it today carrying a bunch of boxes that my wife just HAD to get on Black Friday, and some asshole pushed me out of the way in the Wal-Mart toy section, and so I'd like to get some more therapy. It's hurting a lot right now, and I thought maybe there was a 24-hour therapy place you could send me to. Also, my internist said I'm due for a cholesterol panel, and something else to check my liver because I take a pill for my cholesterol, it's one with a long name, and maybe you could order those labs for me, too."

Voicemail Theater

The following 1 act play was left on my office voicemail this morning.

Female voice: "It says he's closed today."

Male voice: "Closed? Today?"

Female voice: "Yes. Closed. Today."

Male voice: "Why the fuck would he be closed?!"

Female voice: "It doesn't say. A lot of places are closed today. It's sort of a holiday."

Male voice: "That's bullshit. He should know better. What if a patient needs him?"

Female voice: "I can leave a message."

Male voice: "Yeah, but do we want him to call us back?"

Female voice: "It says he will."

Male voice: "I don't want him to. It's just not right that he's closed today."

Female voice: "Okay, what do you want me to do?"

Male voice: "Let's see if we can find another neurologist, with the decency to be open when patients need him."

(click).

November 27, 1898

111 years ago today...

Off the medical and humorous topics, I'm going to indulge my interest in maritime history this morning.

Everyone's heard of the Titanic, Andrea Doria, and Lusitania. But most shipwrecks are long forgotten, except in the areas they occurred.

Long before The Perfect Storm was made famous by a George Clooney movie, there was the Portland Gale of 1898. The storm was catastrophic, but is mostly forgotten now.

In 48 hours of early-winter gale over 300 ships were either sunk or seriously damaged. Lives lost is unknown, but likely between 500-1000. Shore towns and cities from Massachusetts to Maine were devastated by rain, sleet, and more than 2 feet of snow, driven by winds measured up to 110 miles per hour. Communities of summer beach cottages just vanished.

But the storm is still called by the name of it's most prominent victim: the steamship Portland.




In 1898 the Boston, Massachusetts to Portland, Maine route was a busy one, used heavily by both business and leisure travelers. Some took trains, while others preferred steamship. The latter traveled on coastal steamers, usually by night (the equivalent of a "red-eye" flight today). A ticket was $1 to $5, depending on your accomodations. You'd board in the evening, have dinner on the ship, sleep in your cabin, and the next morning were there. The ships went back and forth 3-4 times a week.

The New England weather can be notoriously vicious. A storm was coming in when the Portland sailed on the evening of November 26, 1898. Her captain, Hollis Blanchard, was known for being cautious, but apparently saw nothing in the conditions or forecast that unduly alarmed him. At 7:00 p.m. the ship sailed from India wharf in Boston, never to return.

The ship was sighted by others in the next few hours, but as the storm worsened, eventually vanished in the gale. When and exactly how she foundered will always be a secret, as she took all 192 passengers and crew with her. Recovered watches had all stopped between 9:00 and 10:00, though whether this was a.m. or p.m. is unknown.




The next day wreckage began washing ashore: furniture, timbers, luggage, lifebelts, and lots of bodies. Although the picture above shows a lifeboat being launched, none were ever found, and the severity of the storm makes it unlikely this was even attempted.

Several entire families were lost in the tragedy, traveling home after Thanksgiving in Boston. Their memorials are scattered across New England graveyards. The Portland black community was hit particularly hard, as (except for the officers) the majority of the crew were black men. In 1898 (33 years after the Civil War) service on these ships was considered a very respectable job for a black man, and those who served were generally veterans of the trade, supporting families ashore. They were often more sought after than white men for the same positions, as white men looking for these jobs were younger, less experienced, and seen as more likely to leave the job without notice.

The Portland herself would remain hidden for a long time. In 1989 the wreck was actually located, but the technology wouldn't allow an accurate identification. So it was forgotten again until 2002, when it was found by side-scan sonar. It's since been explored by divers, though at a depth of 460 feet in very cold water this is limited and dangerous.





So that's a history lesson for Friday. It seemed like a change of pace, and I needed to write a post, and I hope you enjoyed it. If you're interested in learning more about the Portland and 1898 gale, I recommend the book "Four Short Blasts" (the title refers to the whistle distress signal of the time) by Peter Dow Bachelder. The book also has a brief history of the American Life-Saving Service, which eventually became the U.S. Coast Guard.

Thanksgiving Memories

Let's take the Way-Back machine to the early-90's.

Dr. Grumpy is the medicine intern, on-call for Thanksgiving, at a large VA hospital (a veterans hospital for my non-U.S. readers, with consequently a primarily cantankerous elderly male population).

A peculiar thing about VA hospitals (at least back then, I haven't worked at one for 15 years) is that patients could sign out at the nurse's desk, and come back later (allegedly they were in the hospital because they were sick, but you need to work at one to understand this point). So the sheet was always full of notations that patients had signed out to go to McDonald's, or to buy cigarettes, or to smoke, or to visit friends at the homeless shelter, or to hold up a liquor store, or whatever.

Some bright businessman had opened a stripper club across the street from the hospital, I think it was called The Jaguar Room. So on Thanksgiving the VA ward I was covering was empty, as most of the patients had signed out to walk, wheel, or crawl over to The Jaguar Room for some female comfort and booze.

I was asleep in the intern's room when the calls began coming in. All of them from the bartender at The Jaguar Room. Questions about was it safe for my patients to be smoking through their tracheostomy tubes? Were the cardiac telemetry packs still transmitting from across the street? Was there a place at the VA where the patients could get more $1 bills, because they'd used them all up on the strippers?

And my favorite:

Bartender: "Can I give Mr. Veteran another beer?"

Intern Grumpy: "Um, what's the problem?"

Bartender: "He has one of those foley bags things, with the tube going up his dick. The bag is, like, REALLY full, and I'm afraid if I give him another beer it'll pop and send piss everywhere."

Intern Grumpy: "Send him back to the hospital."

Bartender: "Well, that's bad for business."

Intern Grumpy: "So is showering your clientele with piss."

Mr. Veteran was wheeled back over to the VA immediately, by a topless stripper no less, who waited while his bag was emptied and then pushed him back to the bar.

A happy Thanksgiving to all, and to all a good night.

Thanksgiving Morning

The kids are watching the Macy's parade on TV, and suddenly start laughing hysterically. I go in to see what's up.

The Rockettes are doing a dance number.

"Daddy! Those ladies aren't wearing any pants, and it's cold there! How could they all forget to put on their pants?"

Hospital Fun

I got called to the hospital yesterday afternoon. Nice old lady (80 +) who got a steroid shot in her back for pain. There were some complications with the shot, and she was (temporarily) paralyzed in both legs.

So, I checked her MRI to make sure nothing horrible had happened, and then went to meet with she and her husband. By the time I got there she was already improving.

Dr. Grumpy: "So you're feeling better now?"

Mrs. Oldbutcute: "Yes, but I was completely paralyzed for a while."

Dr. Grumpy: "Well, that was the medication, and it's wearing off now. It caused you to be dead from the waist down."

Mr. Oldbutcute: "Hell, doc, she's been dead from the waist down for 40 years."

He ducked as a copy of Newsweek came flying at him.

Anatomical Variant

From a history form a patient handed me today:

"I've had both right shoulders replaced twice."

Thank You For Sharing

Dr. Grumpy: "Do you take anything for the neck pain?"

Mr. Kreepy: "Viagra."

Dr. Grumpy: "Viagra isn't a pain medication."

Mr. Kreepy: "Yeah, but when I'm jacking off I don't notice the pain as much."

I need to learn not to ask. Sometimes I don't want to know. And the mental images are never pretty.

Medical Guidelines

Okay, medicine is full of guidelines and acronyms. Phrases like SOAP, BRAT, TURP, CAPRIE, HIT, CABG, CHOP, etc. all have meaning to different specialties.

So (and thank you to reader Kaitlin for bringing this to my attention) there's a scale used to help assess vomiting during pregnancy, called the Pregnancy-Unique Quantification of Emesis index, aka PUQE.

Really. PUQE.

I'm not making this up- Journal of Midwifery and Womens Health. 2009;54(6):430-444.

I can just see something like this:


Frantic husband: "Doctor, my wife is still throwing up!"

Doctor: "What's her PUQE index?"

Frantic husband: "Um, looks like pizza she ate last night, and maybe a cookie. Could be some pickles, too. Hard to tell."