Oh, I'm sure they're used to your type

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

Mr. Platelet: "Hi, I need you to call the pharmacist about my Plavix."

Dr. Grumpy: "What's wrong? I thought Annie called it in earlier today?"

Mr. Platelet: "Yeah, but they're trying to pull a fast one on me. They tried to give me something called Clopidogrel, and they're telling me it's the same. And I've never taken Clopidogrel!"

Dr. Grumpy: "It is the same. Clopidogrel is just the generic name."

Mr. Platelet: "It is?"

Dr. Grumpy: "Yeah."

Mr. Platelet: "Oh crap. Normally my wife picks it up for me, too. I've just never noticed."

Dr. Grumpy: "Same drug. Just go get it."

Mr. Platelet: "Um, can you call it in to another pharmacy for me? After the way I acted I'm too embarrassed to go back there now."

Pizzaball

The Grumpyville city summer sports leagues are always popular, with different divisions for all levels of talent.

Usually one of the best teams in town is 8 guys who all work at Local Pizza. The manager there is the husband of one of my patients. The Pizza Boys have a feared reputation in their division, as they've been friends since high school and play together year round. They've only rarely been defeated.

Until this month.

Mrs. Pizza came in for a routine visit, and I asked how her husband's team did this year.

She paused, then began laughing. Hysterically. When she finally calmed down she told me they'd lost EVERY. SINGLE. GAME. By huge margins, too.

I asked her how this could happen. Was one sick? Injured? Dead? These guys are good (at least by city league standards).

And she began laughing again.

Apparently, due to a busy day at the restaurant, they sent one guy's girlfriend to sign them up at the city park that runs the leagues.

She signed them up for division 5 (normally they play in division 3) by mistake.

Division 5 is guys who are either recently-retired from the NBA, or who came really close to getting into the pro leagues, but weren't quite good enough.

But they are, however, a helluva lot better than a bunch of guys who run a pizza joint.

I was laughing so hard it pretty much ended the visit.

Important details

Seen in a chart while on call this weekend:

FOR FUCK'S SAKE, NO!!!

Seen at Costco, in adjacent aisles, on August 18, 2013:

Once again, my pleas go unanswered.

"I love what you've done with the conning tower!"

While doing some reading about naval battles in the Mediterranean during WWII, I stumbled across this profile of a U-Boat commander.

It was the last line that gave me the giggles.

Patient quote of the day

"We've been trying to get pregnant for a year, but took a break last month to get married."

Downgraded? Wishful thinking? Fight in my lobby?

From the "Emergency contact" section of a patient information form a woman filled out yesterday:

Mary's desk

Mary: "Okay, so we'll see you next Tuesday at 8:15. Any questions?"

Mr. Letter: "I know your office complex pretty well, but where are you in relationship to the 1st floor post office?"

Mary: "There isn't a post office in our building."

Mr. Letter: "Yes there is. I was just in it last month to mail a package. It's on the west side of the first floor."

Mary: "Sir, I assure you, this is a medical building. There isn't a post office anywhere in here."

Mr. Letter: "They must have closed it. It's across from the elevator. How could you not see it?"

Mary: "We've been in this building for over 10 years, sir. There's no post office here. The nearest one is about 4 miles away."

Pause

Mr. Letter: "Are you sure Dr. Grumpy isn't in the building with the post office?"

Mary: "Yes sir. Do you want me to give you our address? You can see a map on our website..."

Mr. Letter: "Why don't you just cancel the appointment. I need to buy stamps and send a package to my cousin, so I'll just try to find a neurologist closer to a post office."

Negative answers FAIL

Dr. Grumpy: "Do you use caffeine?"

Mr. Negative: "No, except for 2 cups of regular coffee each day."

Dr. Grumpy: "Do you take any medications?"

Mr. Negative: "Nope. Only Coumadin and Metformin."

Dr. Grumpy: "Are you allergic to any medications?"

Mr. Negative: "None, just Penicillin."

Don't just stand there! DO SOMETHING!

I hear that all the time. Apparently, standing by the bedside and giving medications isn't enough for some people.

There's a pervasive idea that a high-priced invasive procedure has to somehow be better than doing something simple and conservative. I suppose this is human nature. Our ancestors gravitated toward human sacrifice on the instinctive belief that a deity that demanded human life has to be more powerful than one who wanted rice.

And I'm not knocking surgery, or surgeons, or other invasive procedures. In many cases they are critically important and life saving.

But let me tell you some stories.

The cardiologists have a remarkable technology called the stent. It's a tiny piece of metal that can help prop open a closing artery to restore blood flow. It's changed a lot of the way heart care is practiced during my career.

So it's only natural to extrapolate this technology to arteries of the brain. Instead of doing surgery, or using ho-hum medicines, we started putting high-tech stents into arteries supplying the brain, too.

Guess what? A study found boring old pills beat snazzy stents!

Here's another example:

For acute strokes, TPA is the big thing (I'm not going to argue about how effective it really is). But there's all kinds of things we can do beyond just plain old TPA. After all, how exciting is it to slowly drip some liquid into an IV line?

(crickets)

But it can be so much more exciting! What if we give TPA by threading a catheter all the way up to the brain and drip it right onto the clot? COOL! Or we could also use REALLY flashy technology ("technology always implies it MUST be good, doesn't it?). There are tiny gadgets we can thread all the way up to the brain, screw them (gently) into the clot, and pull it out (WOW! Like a cork!). Or another gadget we can use to punch a whole in the clot and restore blood flow.

Sounds all science fiction-y, huh? Well, we DO have the technology to do all those things.

But does it work? (Wait, who DARES ask such a question of advanced technology?!!!)

Um, no.

That's it folks. 2 studies (here and here) found that all this advanced stuff was no better than boringly watching TPA drip into an IV line. Ho-hum.

Now, the companies who make the fancy gadgets, and the doctors who use them, will gladly point out all kinds of flaws in the studies, and some of them may be legitimate. But some complaints, like "we need to select patients better," translate simply as "let's stack the deck in our favor."

In medicine we hear the phrase "Do something!" a lot. But usually we already are doing something. The problem is that many people think that unless it involves a lot of razzle-dazzle and medical voodoo, we aren't.

And in some cases that's quite far from the truth.

Yet more pictures from the road

I suppose only a neurologist would notice this guy's T-shirt:

Here we have a fashion statement, albeit for a good cause:

 

I don't understand this:

"I want you to remember this, Clark. The one man who hung you from his radiator grill."

More pictures from the road

This bio-hazard bag rode an elevator at our hotel for roughly 24 hours before disappearing. Maybe they wanted us to think we were aboard the Carnival Triumph.

I assume this bumper sticker's purpose is to confuse readers regardless of political leaning.

Catching up on some reading behind-the-wheel while Mrs. Grumpy was driving, I encountered this strange ad for an epilepsy drug. Apparently, if you don't like turning blue, it's easier to be green.

Pictures from the road

Because when you hit a bump on the freeway at 75 mph, nothing holds your overloaded trunk closed better than a few strips of tape.

"That looks safe, Ed. Now use some to re-attach the differential."

Heading out

Okay, folks. The bags are packed. Kids in the trunk rear seats of the minivan, and we are ready to head out for 2 weeks.

As they did last year, my family has forbidden me from writing regularly on this trip. Something about family time and other stuff.

So I'll be posting stuff here and there and as allowed by my superiors, but not daily.

Regular posting will resume on Monday, August 12th.

Traffic jam

Actual broadcast of a road construction news story in Saginaw this week.

I feel incontinent. Let's go for a drive!

Actual manufacturer's info for Botox:

Fool me once...

Wednesday, July 17

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

Miss Luthor: "Hi, I'm so sorry, I have an appointment in 1 hour, and I have to cancel it. I'm really sick today."

Mary: "I'm sorry. Would you like to reschedule?"

Miss Luthor: "Yes. Can I come in next Wednesday, at the same time?"

Mary: "Okay... Wednesday, July 24... Looks good! We'll see you then, and I hope you feel better."

Miss Luthor: "Thank you!"


Wednesday, July  24

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

Miss Luthor: "Hi, I'm so sorry, I have an appointment in 30 minutes and I have to cancel it. I can't get a ride today."

Mary: "Okay..."

Miss Luthor: "I'd like to reschedule to..."

Mary: "I'm sorry, but our office policy is that we don't allow 2 last-minute cancellations."

Miss Luthor: "But I really need to see the doctor! I've heard such good things about him!"

Mary: "I'm sorry, but that's our policy."

Miss Luthor: "Can't you make an exception? I told you! I'm really sick today!"

Mary: "I thought you couldn't get a ride today? You said you were sick last week."

Miss Luthor: "Okay, yes, you're right, I can't get a ride today. And I'm sick too! It's both!"

Mary: "Have a nice day." (hangs up)

We're talking A.D., right?

I was doing a survey recently, and this question came up:

1930? WTF?

I mean, let's do the math here. Realistically (unless you're Dougie Houser) if I qualified in neurology in 1930, it means I'd be 109 now. I'm not saying it's impossible, but pretty damn unlikely.

Of course, there are exceptions.

Patient quote of the day

"All my memories, without exception, are of things that happened in the past. I don't have any other kinds of memories, and I'm really worried about this."

Meow

Dr. Grumpy: "I don't like the sound of this... I want to admit you directly to the hospital. Let me make some calls."

Miss Felid: "Okay... But what about Mr. Fluffles?"

Dr. Grumpy: "Uh, what about him?"

Miss Felid: "Will you take care of him?"

Dr. Grumpy: "Can't your daughter go over to your house?"

Miss Felid: "But he's not there!"

She sets her large purse on the desk, and Mr. Fluffles looks out to see what's going on.

Dr. Grumpy: "Oh! I had no idea you had him here."

Miss Felid: "So can you take care of him?"

Dr. Grumpy: "Why don't I call your daughter?"

Miss Felid: "You've really hurt his feelings."

Random weekend pictures

 Time to hit the mailbag.

The first item is this gadget. In all honesty, I had no idea there was a market (especially in "scenic region") for an explosion-proof telephone

Next is this game, which was seen recently at the store. If your "favourite childhood memories" are from the late 1800's, the odds are your kids won't be impressed with it at this point in their lives.

Here we have a gift bag from a child's sports-themed birthday party. They probably should have folded the left margin a little more carefully.

Here's a product that I had no idea existed. I guess it can be used for cooking, for edible jet engines, and, uh, other practices.

And, lastly is this device. Which sounds like a bad pick-up line.

"Light & easy to handle." Snicker.

Great patient quotes

Dr. Grumpy: "Have you had anything stressful going on?"

Mr. Golf: "No. Look, doc, I'm retired. REALLY retired. If I tried to relax any more I'd be comatose."

He's dead, Jim

This question came up on a survey last night (PD = Parkinson's Disease):

I really love the 5th answer. In all honesty, I can't recall ever having received a patient referral from a pathologist.

Which is probably good.

Department of the Obvious

Actual headline this afternoon in USA Today:

Thank you, SMOD!

Tuesday afternoon

Mary: "I can't believe it's this empty."

Dr. Grumpy: "Maybe because it's summer."

Mary: "The phone is barely ringing this afternoon."

Dr. Grumpy: "You should start calling people."

Mary: "Who should I call?"

Dr. Grumpy: "I don't know. Just get out an old phone directory, and start randomly calling people. Tell them they have an appointment tomorrow."

Mary: "Yeah, right. Who's going to believe that?"

Dr. Grumpy: "When they say you have a wrong number, tell them they were referred for memory loss."

IT'S A MIRACLE! HALLELUJAH!

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

Mr. Wheelchair: "My legs are completely paralyzed! I can't walk!"

Dr. Grumpy: "How long has this been going on?"

Mr. Wheelchair: "2 months, and no one can find a cause for it."

Dr. Grumpy: "Do you..."

(patient's cell phone rings, and he looks at it)

Mr. Wheelchair: "Hang on, doc, I have to take this. Let me step out."

(Gets out of wheelchair, walks out to lobby, mumbles into phone for a minute, hangs up, comes back and sits in wheelchair)

Mr. Wheelchair: "Anyway, they tell me there's nothing wrong with me, and that my tests are normal. It's very frustrating, because I can't move my legs at all, and..."

Thank you for this interesting consult

Actual chart note I saw on Friday:


"Patient has history of Alzheimer's disease. Currently has obvious memory deficits. Will consult neurology to see if they can find a cause for his memory loss."

Broadcast journalism

Yes, folks, this actually aired today on California TV station KTVU.






They've since apologized, and both they and the NTSB are blaming the error on an unidentified "summer intern."

Patient quote of the day

From a retired surgeon:

"I had surgery for osteomyelitis as a kid. We didn't have all that fancy antibiotic shit they do now."

Fun with Mary

Sometimes an annoying patient won't take no for an answer.


Mr. Pest: "So, Mary, can we get together this Saturday?"

Mary: "No, thank you. I have plans."

Mr. Pest: "Come on... we'll have fun."

Mary: "I'm not interested, sir. I have a boyfriend."

Mr. Pest: "You could still go out with me."

Mary: "Okay, how about you and I take a drive over to Southtown this weekend? Could you pick me up?"

Mr. Pest: "Sure, but Southtown? By the prison? That's a terrible area. Why do you want to go there?"

Mary: "My boyfriend needs a ride home. He's being released on parole."

Mrs. Grumpy agrees

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

Nurse Newbie: "Hi, I'm the nurse taking care of Mr. Harry Plegia, in room 842."

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

Nurse Newbie: "Well, there was a consult written for you to see the patient 3 days ago, and we never heard back from you. I was wondering if you'd even gotten it, and when you'd be by to see him?"

Dr. Grumpy: "Um... I did the consult 3 days ago. And I've been following him daily since then."

Nurse Newbie: "Really? Because there was a family member here about 2 hours ago, who was looking through the chart, and told me he wanted to get another MRI. I don't know how he got the chart. Anyway, I called the hospitalist, and he told me to run it by you."

Dr. Grumpy: "Two hours ago? That was me! I came over and told you I wanted to do another MRI, but the computer ordering system was down when I tried to put it in."

Nurse Newbie: "That was you? Not a family member?"

Dr. Grumpy: "Yes!"

(pause)

Nurse Newbie: "Doctor, you really should dress better."

Pulp

Miss Print: "Hello, Throwaway Rags, can I help you?"

Dr. Grumpy: "This is Dr. Ibee Grumpy. You guys shipped me a huge box of magazines for my lobby."

Miss Print: "Let me see. Yes, you're on our list to receive 50 copies a month."

Dr. Grumpy: "I didn't order them, and I don't want them. Please take me off the list."

Miss Print: "Have you looked through our magazine?"

Dr. Grumpy: "Yes. It's 90% paid advertising, extolling the virtues of Wirth-Liss Pharmaceuticals overpriced medications."

Miss Print: "Well, Wirth-Liss Pharmaceuticals is paying for every neurologist to receive 50 free copies to share with your patients. Education is important. You can place them in your lobby."

Dr. Grumpy: "I don't want them in my lobby. I put them in the recycling. And I don't want to get anymore."

Miss Print: "You're depriving your patients of an opportunity to learn about their treatment options."

Dr. Grumpy: "I'm not going to argue with you. Either cancel my subscription, or let me talk to your supervisor."

Miss Print: "I'll cancel it. But you're really doing a disservice to your patients. They deserve better."

Phonetics

In the mid-2000's there were several government hearings concerning the safety of the COX-2 family of drugs (Vioxx, Bextra, and Celebrex).

A colleague of mine was working for the FDA at the time, and had to sit through hours of testimony on them. He sent me this remarkable e-mail after one:

"Today we had a military doc testify. He told us that the drugs are important in military use, because they can get injured soldiers back into battle sooner.

"He finished his speech by declaring 'Soldiers need COX-2!'

"And that just doesn't sound good when spoken."

Great copywriting moments

"Maybe an orthopedist would be better?"

Source: Here.


Thank you, M!

Footprint?

I'm not sure what to make of this.

This fan-shaped area of flattened grass wasn't there when we left yesterday morning, but it was definitely there when we got home late afternoon. It looks like a giant footprint:

Mello investigates

Anyway, if your pet therapod has escaped somewhere in Grumpyville, I think it was in my backyard today. Hope that helps.

Thank you for sharing

Mary: "Okay, I'll let Dr. Grumpy know you're here, and he'll take you back in just a minute."

Mrs. Knickers: "Do you have a bathroom I can use first?"

Mary: "Sure, it's that door to your left."

Mrs. Knickers: "I need to change my underwear. You wouldn't believe the drive I had here."

Fiat lux

Dr. Grumpy: "Let's go to my exam room..." (walks into exam room, flips on lights)

Mrs. Photic: "OH MY GOD! DID THE LIGHTS JUST FLICKER?!!!"

Dr. Grumpy: "Uh, I think so, when I turned them on. They're fluorescent."

Mrs. Photic: "THIS MEANS SOMETHING!"

Dr. Grumpy: "Everything is fine, ma'am. It only means they're on. Have a seat over there, and let me take your blood pressure.."

Mrs. Photic: "They're not going to flicker again, are they?"

Dr. Grumpy: "I don't think so, but they're old fixtures."

Mrs. Photic: "If they do, I'm leaving. For all I know you're one of them."

Um, okay, you can call it that

Frank & Craig were at sailing camp on Lake Grumpy yesterday.

This picture was in the "Sailing Instructions" pamphlet they were given.

Immature? Why yes, I am!

History reruns

June 30, 1908.

One of the most remarkable events in history happened on this date. And it's mostly forgotten.

At 7:14 a.m. a MASSIVE explosion occurred near the Tunguska river in Russia. I'm not exaggerating. The force was somewhere between 5-30 megatons. Think about that: an explosion between 150 to 1000 TIMES the power of the Hiroshima nuclear bomb. And it happened 37 years before the nuclear age began.

And, purely by chance, it happened in a fairly uninhabited part of the Earth.

To this day its exact cause is unknown, and it's simply called "The Tunguska Event." It's generally believed to have been a meteorite or comet that exploded before hitting the ground.

The shock wave it sent through the ground was a 5.0 on the Richter scale. Every tree in an 8 km (5 mile) radius from the center was killed, and the force of the explosion covered a total of 830 square miles (2,130 square km). An estimated 80 million trees were knocked over by the force- all of them pointing away from the center. A few were left standing, scorched black, with all their branches stripped off. People were knocked off their feet, and windows shattered, hundreds of miles away. The pressure wave was measured as far away as England. For the next several months there was a change in the density of the planet's upper atmosphere.

An eyewitness 40 miles south of the explosion, reported that "At breakfast time I was sitting by the house at Vanavara Trading Post, facing north. I suddenly saw that directly to the north, over Onkoul's Tunguska Road, the sky split in two and fire appeared high and wide over the forest. The split in the sky grew larger, and the entire northern side was covered with fire. At that moment I became so hot that I couldn't bear it, as if my shirt was on fire; from the northern side, where the fire was, came strong heat. I wanted to tear off my shirt and throw it down, but then the sky shut closed, and a strong thump sounded, and I was thrown a few yards. I lost my senses for a moment, but then my wife ran out and led me to the house. After that such noise came, as if rocks were falling or cannons were firing, the earth shook, and when I was on the ground, I pressed my head down, fearing rocks would smash it. When the sky opened up, hot wind raced between the houses, like from cannons, which left traces in the ground like pathways, and it damaged crops. Later we saw that many windows were shattered, and in the barn the iron lock had snapped."

There have been other impacts in recorded history, but none this powerful. And, over 100 years later, the scars are still there.



1921: 13 years after the event.







2008: 100 years after the event.


And, just remember: we live in a solar system full of flying objects.

Dear Mrs. Soda,

Please do not leave a message that you changed your mind and want to take a medication.

And, when we call you back 20 minutes later, say that you changed your mind again and now you don't want anything.

Then call just after closing to say you've changed your mind again, and would like me to call something in.

And not have a pharmacy number, or even know what pharmacy you want it called too, when I dial you back.

Then yell at me for not knowing which pharmacy accepts your insurance.

The guilt is strong with this one

It's 4:00. A guy comes in, stands at the counter.

Mary: "Can I help you?"

Guy: "Um... Yeah, I had an appointment today at 1:00, and I got called into work, and called you at around 9:00 to cancel it."

Mary: "Yes... I see that on the schedule. Did you need to reschedule?"

Guy: "I'm not sure... I mean, you're not angry at me, are you?"

Mary: "Uh, no, these things happen."

Guy: "Okay, I've been really worried about that. Thanks!"

(leaves)

Lalataw

I saw this in a hospital chart note this morning:

No, I have no idea what it means.

I've never heard of Lalataw. And I don't know why someone would, or wouldn't, want to be active in it.

Or what it has to to do with a stable guy admitted for a headache, anyway.

No fireworks

Sorry, people.

For all those writing in wanting to know what happened with Mrs 9:30, the answer is... nothing.

After getting off the phone with Mary that afternoon she looked at my office website, and realized just who the male receptionist was.

She called back and cancelled the appointment, then went to a doctor-rating site and wrote a scathing review of me and the appointment that never happened. I suspect she broke her caps-lock key in the process.

Don't ask

Dr. Grumpy: "What was your last hemoglobin A1c?"

Mr. Insulin: "7.1."

Lady Insulin: "Was it? I thought it was 8.2?"

Mr. Insulin: "No, Dr. Endocrine said it was 7.1 at my appointment last week."

Lady Insulin: "That was my appointment. Yours was in March."

Mr. Insulin: "I thought your A1c was 7.9 in March?"

Lady Insulin: "No, that was your appointment."

Mr. Insulin: "Mine was 7.1. You put it in your phone."

Lady Insulin: "I thought you put it in your phone?"

Mr. Insulin: "Why would I put yours in my phone?"

Lady Insulin: (takes out a phone) "Whose phone is this, anyway?"

Mr. Insulin: "I think the 8.2 was Sylvia's. She mentioned it at dinner last night."

Lady Insulin: "Dr. Grumpy, can you call Dr. Endocrine for us?"

We're gonna turn it on. We're gonna bring you the power.

Holy crap! Is that Morgan Freeman?

For those of you who absolutely can't bear to lose at videogames, you now have a new way to win.

For only $249 the company FOC.US is selling a headset that will run an electric current through your brain (specifically, the prefrontal cortex). Their website says it will "increase the plasticity of your brain. Make your synapses fire faster." They're marketing it as a way to improve your videogame skills for the "ultimate gaming experience."

Really.

It also comes with an iPhone app to control your jolts. And it's in your choice of red or black.

"Now I can kick my boyfriend's ass at Call of Duty."

Now, I'm not going to knock the uses of electrical brain stimulation. This is an area that's currently undergoing a lot of research as a way to treat disease and help people recover from strokes and other causes of brain damage.

But, on the other hand, let's keep a few things in mind:

1. This is electricity, for fuck's sake. It's dangerous.

2. We used to execute people with this.

3. If winning at Halo is that important, you need to get out more.

I'm sure people from FOC.US will point out that their gadget uses a low level of juice, which isn't going to hurt you (on the other hand, I have no idea if it will help. The last video game I mastered was Atari Adventure).

I have to be a bit skeptical about its benefits. I mean, the internet is full of people selling herbs, magnets, and who knows what else as ways to improve your performance at work, the gym, and in bed. Most have nothing more behind them than some half-assed data and anecdotal claims. While I think the jury is still out on cortical electricity, that doesn't make their claims true.

Another issue is that for many people, after you've plunked down a boatload of money for a game system, they don't have $249 to blow on this gadget. So what do they do?

Well, according to a recent editorial in Nature there's concern that people will start doing this as a do-it-yourself project. You could wire up with some batteries at home, or whatever you can find in the garage. There are even companies selling DIY kits for it online. This is where I think the editorial has its best line:

"That’s ‘could’ as in ‘you might be able to’, by the way; not ‘could’ as in ‘it’s a good idea’."

Granted, that's never stopped anyone from doing stupid stuff. Bigger, in the general perception, must be better. If a little battery can improve your score, then shouldn't plugging into your home's AC current be great? By the time you're playing an X-Box hopefully your parents have pulled those plastic things from the outlets that kept you from sticking a fork in them. The target audience here isn't known for being averse to risk.

What could possibly go wrong?

"Mario and Luigi, here I come!"

I also have to worry about how far this could go. What if electricity does clearly improve brain performance? Can't you just see pushy parents wanting to plug their kids in to get a better SAT score? Or a med school gunner wearing some shockware into a test, disguised as earplugs?

This could end up as the academic equivalent of athletic steroids. The next cheating scandal could be some guy tossed out of a math competition for illegal wiring.

Lance was stripped of his high school math letters when it came out he'd been "volting."

So, in closing, my point is this: low-level trans-cortical electrical may have medical utility (personally, I suspect it does). But if that "may" makes you want to shell out more money just to beat your brother at Grand Theft Auto V, then I've got some buildings in Rungholt to sell you.

"Superman warned me the electrodes would do this. Why didn't I listen?"

Thank you, SMOD!

Hazards of "V" and "C" being next to each other on the keyboard

Thank you, M!

"I'd like to buy a comma, Pat."

What are "heart joints?"

"I don't remember those from Netter."

Excuses

"Well, officer, I was in a hurry to get home and start waxing it."

Why I call him that

Drug rep: "Hi, Dr. Pissy. Lunch today is from Dave's Deli."

Dr. Pissy: "Dave's Deli? Why? What did I ever do to you?"

Ooooh! Fireworks!

Yesterday Mary had to take her kids to an early dentist appointment, and wasn't able to get here until 10:00. Annie was stuck in traffic, so I took over the front desk since the first patient, a new one, was scheduled for 9:00.

The patient showed up at 9:30, WAY too late (in my opinion) to try and see a new patient. So I told her she'd have to reschedule. She wasn't happy about it, and asked to see a different doctor, or a PA or NP. I told her we don't have anyone else, and so she finally rescheduled to next Tuesday.

Later in the afternoon:

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

Mrs. 9:30: "Yeah, I had an appointment this morning, and had to reschedule it to next week."

Mary: "Yes?"

Mrs. 9:30: "I just want to complain. The male receptionist who was working this morning wouldn't let me see the doctor. I didn't like that at all."

Mary: "Male receptionist... Oh, that was..."

Mrs. 9:30: "I don't care what his name was. The doctor needs to know his staff is turning patients away. Even if they show up late, it's still inappropriate. My time is valuable."

(long pause)

Mary: "The doctor is aware of what happened."

Mrs. 9:30: "Good. Because I want to be sure to tell him about that guy at my appointment."

Mary: "You'll definitely have the opportunity."

Looking forward to Tuesday!