Fine, then call Google

Dr. Grumpy: "What you have is called Essential Tremor. It's a form of tremor that..."

Mrs. Parscompacta: "Wait, are you saying I don't have Parkinson's disease?"

Dr. Grumpy: "Correct. Essential tremor is a different disorder that..."

Mrs. Parscompacta: "This is ridiculous. Of course I have Parkinson's disease."

Dr. Grumpy: "Why do you say that?"

Mrs. Parscompacta: "Because the internet says I do!"

Dr. Grumpy: "Ma'am, I can assure you that you don't..."

Mrs. Parscompacta: "I DEMAND YOU DIAGNOSE ME WITH PARKINSON'S DISEASE!!!"

Dr. Grumpy: "Why do you want Parkinson's Disease?"

Mrs. Parscompacta: "I'm your customer, damn it! Haven't you ever heard 'the customer is always right'?"

Dr. Grumpy: "Yes, but for this..."

Mrs. Parscompacta: "You're the 3rd neurologist I've seen, too. Obviously, I've learned more from Google than you idiots did in training."

Dear Helen Keller Services for the Blind,

Yesterday you sent this email to one of my readers, who kindly forwarded it to me.

And beyond that, I'm not going to say anything.

Thank you, Dilbert!

Hmmm...

Mr. Skip: "My pain is better, but I still have bad days, about once a week. I don't know why."

Dr. Grumpy: "Any side effects on the medication?"

Mr. Skip: "No, but I just don't like taking pills."

Dr. Grumpy: "They seem to be helping you, though."

Mr. Skip: "Yeah, but I'm just not a pill person. I skip taking them every 5 days to see if the pain comes back. It does."

Front counter

A lady comes in to the waiting room, sits down, and grabs a magazine. Other patients come and go, and after a few minutes Mary goes to the counter.

Mary: "Hi, ma'am. Are you here to see Dr. Grumpy or Dr. Pissy?"

Lady: "Neither."

Mary: "Oh, are you picking someone up?"

Lady: "No."

Mary: "Do you need to make an appointment?"

Lady: "No, thank you."

Mary: "Is there anything I can help you with?"

Lady: "No, I'm just reading the magazines. I didn't like the ones Dr. Lung has across the hall, and told them they could find me over here."

Patient quote of the day

"It was dark. I mean, pitch black. I was afraid I'd completely lost my vision and was blind. But then I found the light switch, and flipped it. That made everything fine, and I could see again."

Money changes everything

Dear Dr. Cashpay,

I know you don't remember what it was like to be a peon. It's been several years since you last saw an average patient. Nowadays people pay you $5000/year to "belong" to your practice, and then another $400/hour if they actually have to see/speak/text/stand in your radiant aura.

And you normally don't refer to me, anyway. Since I take insurance, I get paid the same amount of money to see one of your self-important assholes as I do for a decent, but non-wealthy person. So I don't give your patients the priority attention you feel they deserve. But, occasionally, one of them will show up on my doorstep and I'll see them. As did Mr. Rich last week. Unlike most of your peeps, he was quite pleasant.


3 days later:


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

Lacey: "Hello, this is Lacey, calling from Dr. Cashpay's office. He wishes to discuss Mr. Rich's case with Dr. Grumpy."

Mary: "Hang on, he's between patients, so let me get him."

Lacey: "No, we don't work that way. He'd like to schedule a 15-30 minute appointment to discuss Mr. Rich by phone."

Mary: "Wait... You're actually trying to schedule a phone call for the doctors to talk?"

Lacey: "That's what we do here."


This was a first for my office. Mary grabbed me, and I got on the phone.


Dr. Grumpy: "Hi, this is Dr. Grumpy."

Lacey: "Dr. Cashpay would like to schedule a 15-30 minute phone appointment to discuss a mutual patient."

Dr. Grumpy: "That's a lot of time. Is Dr. Cashpay going to pay me for this phone call?"

Lacey: "Certainly not. He works for his patients."

Dr. Grumpy: "But he'll charge Mr. Rich for the time he spent on the phone on his behalf, right?"

Lacey: "Of course. And rightfully so."

Dr. Grumpy: "Look. I've get about 5 minutes on the phone between patients right now. So Dr. Cashpay can talk to me now, at no charge. But I really don't have time to set up phone appointments for this sort of thing."

Lacey: "He's with a patient, and doesn't allow interruptions."

Dr. Grumpy: "Then he can try later, and see if I'm available. Show him how to dial. Goodbye."

Overheard at the Nurses Station

It's shift change:


Nurse 1: "Beware of when she coughs."

Nurse 2: "Why? She really sick?"

Nurse 1: "No. When she coughs, she farts. And sometimes more."

Wrong Way Wooten

Dear Dr. Lazar,

One of my readers noticed an ad for your recently published book:

I'd like to make 2 points (so to speak).

1. While your book is on stomach cancer, and I understand anatomy is important, the breasts seem unusually voluptuous detailed for a book that focuses on an entirely different organ system.

2. In a book about stomach cancer, some details are more important than others. The anatomy of the stomach, for example, is pretty critical. And in this case, your cover art has it backwards. So, unless you've got an exceedingly rare patient born with reversal of the internal organs, or a previously undescribed form of malignancy that causes them to rotate a perfect 180°... I'd break out your Netter.

Thank you, Robyn!

Hmmmmm...

Dr. Grumpy: "Are you married or single?"

Mr. Shakes: "Um, do you think the girl who drove me can hear us? She's out in your lobby."

Dr. Grumpy: "No, not through these doors."

Mr. Shakes: "Then I'm single."

Correct!

Dr. Grumpy: "Have you had any surgeries?"

Mr. Cecum: "I've had a unilateral appendectomy."

Mary's desk

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

Mr. Sativa: "I need to make an appointment."

Mary: "Okay, what will you be seeing the doctor for?"

Mr. Sativa: "I need my transmitters or transistors checked in a test."

Mary: "I'm not sure what you're talking about. What symptoms are you having?"

Mr. Sativa: "I don't know if I'm having symptoms or not. See, I've been smoking weed for years, and 3 days ago I stopped cold turkey because I needed the money to get my car fixed, and I need that test to see if my brain is, like, really fried."

Mary: "And what test did you say it was?'

Mr. Sativa: "I want my transistors, or transmitters, or whatever those things are that radios and TV's and power stations have, you know, except they're in your brain. I read about it on the internet."

Mary: "I'm not sure..."

Mr. Sativa: "Also, I need to know how much it costs, too, because now that I'm not smoking weed I'm trying to save money, in case I need more tests, or go back on weed, or get my car repaired again because it still isn't working right. It makes this weird noise, like a rabbit is trapped in the glove compartment, and I looked and there's no rabbit there, or bird, or anything. Do you know what can make a noise like that? Or can you ask the doctor?'

Mary: "Why don't you call Dr. Hehatesusandwehatehim, down the street. He does this test."

Mr. Sativa: "Oh, cool. Does he know anything about cars, too?'

Texting with Frank

Frank and I are usually texting back and forth in the afternoon, as I have to pick him up and take him to Kumon, or home, or heaven knows where.

Unfortunately, this isn't nearly as easy as it sounds. For example, here's one where I wanted to know if he was going to stay at a friend's house, or was ready for me to come get him.

 

Another issue is the somewhat unusual messages he sends:

 Or his attempts to get out of going to Kumon:

Or the ones that warn me there's a mess waiting at the house:

And yes, he did use the SodaStream CO2 cartridge. A brand-new, sealed, one, completely emptied in Frank's attempt to build an anti-zombie weapon. You have no idea of the looks you get at Target when trying to exchange an empty SodaStream cartridge that has "DESTROY ZOMBIES!" painted on the side.

Monday night, 8:45 p.m.

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

Mr. Quattro: "Hi, I'm a patient of Dr. Brain, and ran out of my pills. Can you call them in for me?"

Dr. Grumpy: "What pill is it?"

Mr. Quattro: "The tan one. It's from Dr. Brain."

Dr. Grumpy: "Do you know its name?"

Mr. Quattro: "It's on the Walmart $4 list. Does that help?"

Weekend on call

Early morning Sunday, I go in to see a new hospital consult.

I walk into the nurse's station, looking for the chart. One of the nurses is on the phone, looks up at me, and says, "Doctor, it's for you."

She shoves the receiver into my ear and disappears into a room with a blinking call light.

Dr. Grumpy: "Uh, hello?"

Voice: "What do you think of her?"

Dr. Grumpy: "Who is this?"

Voice: "This is Mr. Smith. Are you the neurologist seeing my wife?"

Dr. Grumpy: "Yes, but I literally just got here. I haven't been in the room, or even seen the chart yet."

Voice: "Well, what's going on with her?"

Dr. Grumpy: "Sir, I just got here. I have no idea yet. I can call you back..."

Voice: "Okay, what do you think is going on with her?"

Dr. Grumpy: "I haven't had a chance to..."

Voice: "Okay, you obviously don't have the answers we need. Don't bother seeing her, I'll have them call another neurologist."

(Hangs up)

Today's lesson from Snowball

Never knock over a trash can and walk in. Someone might stand it back up.

Truth or Consequences

Last night, trying to be a nice guy and participate in the hospital's community outreach program, I gave a talk to a roomful of senior citizens about Alzheimer's disease.

One guy interrupted me 3 times to ask what a neurologist does.

I'm still not sure if this was real, or if he was intentionally fucking with me.

Crossing over

 

A friend of mine, while traveling, recently took her son to a doctor in an unfamiliar area for a semi-urgent issue. While there the staff tried to sell her weight loss supplements (and she's slim), asked her (and she wasn't the patient) if she had foot numbness (giving her a brochure about a pseudo-NCV procedure they do), and tried to talk her into a sleep study. She hadn't raised any of these issues, but they were repeatedly brought up by the physician and his staff while treating her daughter.

Pissy and I call this "The Dark Side." And, unfortunately, it's a growing trend in medicine.

Insurance reimbursements dwindle, and so doctors try to find "alternative revenue" streams. Sometime they aren't a bad idea, but other times they're simply unnecessary tests and/or ineffective treatments done solely to increase profits. The worst are where they involve an invasive, potentially hazardous, procedure that has no proven benefit. Pointless biopsies that won't change a treatment plan, gadgets to relieve pain that aren't statistically superior to placebo, supplements sold at the front counter with extravagant claims to cure Alzheimer's, and other horseshit.

Doctors who do this likely start out as well-intentioned, and end up on a slippery slope. As the revenue stream increases they get greedy, adding more and more bells and whistles to the practice- at the cost of patient care. Like Anakin Skywalker, they become seduced by the Dark Side, needing to keep expanding their practice away from what's best for the patient.

Of course, they won't admit that. To them the new laser-magneto-hydrological thingamajig they put in to cure chronic halitosis at $100 a pop is medically necessary. It's not covered by any insurance, or even mentioned in any reputable publications, but the company that sells it has infomercials on TV and glossy booklets for the waiting room. Likewise, there are some procedures that are covered by insurance but have no real medical evidence to support them. And they're also done purely for profit.

Years of moving in that direction have convinced the doctors involved that these things are the standard of care. Like Darth Vader, once you cross the line there's no going back.

I get calls from companies selling this stuff, too. Usually Mary filters them out, but occasionally they reach me. Or fly in under the radar by claiming to be a drug rep. They show me graphs of start-up costs and how much money I can make (usually insane amounts, like $100K per month, with an asterisk noting that's only if you see patients 24/7).

I try to be polite, but in my mind I hear them speaking in a deep voice through slow, heavy, respirations, asking me to join them on the Dark Side,

Luke tossed his lightsaber aside and walked away. I just thank them and head back to my desk. I may not be getting rich, but at least after 15 years of this I can still face myself in the mirror and believe I'm doing what's right for my patients.

Crime in America

Thank you, Don!

Mary's desk, Tuesday afternoon

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

Mrs. Bland: "Hi, this is Katie Bland. Our daughters are in kindergarten together, and had a playdate last weekend at Local Park."

Mary: "Yes, she had a good time. I remember, you and I talked about the school's fundraisers."

Mrs. Bland: "Yeah. Anyway, my husband and I were wondering if you and your fiancé are interested in swinging with us at the Daisy Chain Club this weekend?"

I'd say you're doing pretty well

Dr. Grumpy: "Do you have any other health problems?"

Mrs. Octogenarian: "I have Hufnagel's disease."

Dr. Grumpy: "If I remember correctly, that's a pretty serious illness."

Mrs. Octogenarian: "It's fatal. I'm terminally ill."

Dr. Grumpy: "How long have you been terminally ill?"

Mrs. Octogenarian: "57 years."

Quiz time

A friend of mine was recently taking a practice test for the Emergency Medicine boards, and came across this question:

A day at my office

Thank you, Elmo!

Thursday afternoon

A touching mother-daughter moment in my office:

"Mom, when I get to heaven I'm going to kick Dad's ass for leaving me alone with you."

Uh, Dan... on the screen behind you, Dan...

From Huffpost.

Medical science marches on

This spring Local Hospital installed a new hand washing system. Apparently the old system of soap and water wasn't doing what they wanted (what they wanted I'm not sure, because we were using it to wash our hands).

The new system they installed involves, okay, soap and water (revolutionary, huh)? But it also involves a new technology- the hand-washing entertainment system. REALLY.

Studies have recommended that you wash them for 15 seconds to kill/drown the majority of germs, and most people don't do the full quarter-minute. So, in order to keep you washing, it tries to keep you entertained. And what better way to do that than with a screen? After all, in the 4 million years since we split off from the rest of the primates, staring at screens is what our species truly excels at.

As soon as you pump soap onto your hands, the show begins. Almost always there's a timer on it, counting backwards from 15, to make sure you scrub for your allotted time.

Usually it also involves telling you the weather outside. Which is, if you think about it, a real "fuck you." If you're washing your hands at the nursing station it means you're working, and there's no way you're getting outside to enjoy the day no matter how nice it is.

It also features all kinds of other stuff. Here's some examples.

If you like sports, it keeps you updated on scores while you think about your buddies with the day off having a tailgate at the game:

Sometimes you get a bit of semi-wisdom fortune-cookie-ish sayings. Like you really need that while trying to get an unhelmeted motorcyclist's shit out from under your fingernails.

 

Cute sayings are also common fodder. Who needs a self-help book when you can just get a daily dose of happy-happy joy-joy by washing your hands?

 

Ever find yourself suddenly struck by a panic attack that you'll be on a quiz show and not know the answers (or, if it's Jeopardy!, the questions)? Fear not! The magic handwashing gadget is happy to share pointless trivia.

For those at other hospitals using this system, feel free to send me shots of your hand-washing entertainment. I'll edit out any identifying info if needed, and perhaps make this a regular feature if popular enough.

NOTE - Dr. Grumpy, Inc. will not be responsible for any water damage your phone may suffer in the mad rush to scrub poop & blood off your hands and get your phone out during the allotted 15 seconds.

Still a few bugs in the system

Last night I was doing a survey about a new medication, and encountered this question:

The Long and Winding Road

 

Guy walks in, stands at counter.

Mary: "Hi, can I help you?"

Mr. Far: "Yeah, I have a new-patient appointment with Dr. Grumpy for 2:00."

Mary: "Oh! You must be Mr. Far. It's 1:30 now, but that gives you time to get started on your paperwork..." (hands over a clipboard) "and can I get a copy of your insurance card?"

Mr. Far: "Sure..." (take clipboard, rummages through wallet, hands card to Mary) "I left my house early to make sure I had plenty of time to get here."

Mary: "That's fine. If he's done with his current one early, he'll usually start with you."

Mr. Far: "I had no idea how far you were from my house."

Mary: "I'm sorry. I thought you lived in South Grumpyville?"

Mr. Far: "I do... It was a 30 minute drive here."

Mary: "Isn't that what I told you it would probably be?"

Mr. Far: "Yes... You were right. I just hadn't realized it was that far."

Mary: "Well, you made it here early, which is better than late. Here's your insurance card back, thank you."

Mr. Far: (puts card back in wallet) "My GPS even said it would be this far, so I left early to make sure I had enough time. Still... it seemed like a long drive."

Mary: "I'm sorry. Did you have a question about the forms? Or need a new pen? Let me get you another one..."

Mr. Far: "No, let me give this back to you" (hands clipboard and pen back) "I... I think this is too far for me. I'm just going to leave and try to find a neurologist closer to my house."

Mary: "Are you sure? I mean, you're already here, and have an appointment in a short while?"

Mr. Far: "Yeah, this is just too far for me to drive. Thank you, anyway." (leaves)

Sunday afternoon

So, as hunter-gatherer tribes have done for the past several million years, Craig and I went on our weekly hunting & gathering expedition to Costco yesterday.

One of the items I needed for our cave was a chair mat. I'm notoriously rough on these things, and 6-12 months is about average for me. So I grabbed one off the pile, and was carrying it by the handles

When I got to check-out, the guy took it from me and set it upright in the cart, saying this would make it easier to transport. So it looked like this:

Side view

Front view

Seemed like a good idea. This way, if I was attacked by stone-throwing members of the rival Samsclub tribe, I'd have a shield.

Until I tried to push the cart. When I discovered I had this view:

Yes, that's Craig in front of the cart, trying to help me navigate my way out without killing anyone or denting another family's dinomobile.

After a few minutes of struggling with this, some 10 year-old walked by and said, "Mister, why don't you just pull the cart instead?"

Craig still hasn't stopped making fun of me (though it's not like he thought of it, either).

Patient quote of the day

"My mom and I are the same age, but my Dad is younger than me."

Dear Job Recruiter,

Thank you for this ad I received in the mail yesterday.

Let me give you a few pointers:

1. Neuro-Hospitalists are just neurologists, like me. The only difference is that they only work in hospitals. Granted, I don't call myself a Neuro-Officist. Probably because some idiot would pronounce it as "Neuro-Orifice."And calling myself (more accurately) a Neuro-Hospital-Officist just sounds silly.

My point here is that we don't wear surgical hairnets. Or gowns. Or gloves. I suppose if you worked in a hospital you could wear scrubs all the time, but there's no point to the other surgical accoutrements. I do know one Neuro-Hospitalist (I'm not sure it needs to be capitalized either, but you started it) who didn't match into neurosurgery, but 15 years later still plays make-believe by rounding in scrubs with a surgical hat & booties. But that's not normal.

Also, if you're going out of the way to wear sterile surgical gear and look official, you just contaminated your gloves by touching the film.

2. Holding up X-ray films is so 1990's. It's all on a computer monitor now. If the hospital you represent is still using films, that's not a good selling point.

3. It's a freakin' X-ray of a skull. Now, I know you're just a job recruiter, and likely grabbed some stock footage, but this isn't what neurologists look at. We look at MRI's and CT's, NOT PLAIN X-RAYS!!! Especially of a skull. While the skull is of relevance to neurosurgeons and ENT's, my tribe is more concerned with what's inside it. Unless this hospital is still using pneumoencephalograms as a diagnostic tool, a neurologist won't be looking at skull films.

4. If a plain X-ray of a skull is the best neuroimaging this hospital can do, they need a lot of things more than they need a Neuro-Hospitalist.

Yours truly,

Ibee Grumpy, M.D.

Next week

I'll be back sometime next week guys. Thank you for your patience.

Thank you

No, I'm not back to writing. I just wanted to thank you all for your wishes. I'm genuinely touched.

It's been a bad week. I've likely cried more than I ever have. I'm not one of those "boys don't cry" types, but am still in shock. Maybe someday I'll write about it.

One of the most remarkable things (at least to me) about the brain is its ability to remember songs and lyrics, long after we last heard them, or even remembered they existed.

Although I haven't heard the album in over 35 years, somewhere during the week my brain dragged out a song from my childhood that I'd long since forgotten about, and been playing it nonstop in my mental background. It's from Free to Be You and Me (1972) and is "It's All Right to Cry." It was, ironically, sung by football great Rosey Grier.

Normally my earworms drive me nuts, but this one has been very soothing. Thank you, Mr. Grier, wherever you are.

And thank you all for your good wishes and understanding.

IG

Sorry

Due to a serious family emergency I'm going to have to stop blogging for while. I have no idea when I will be back. I will return though, I promise. Please be patient.

Rimshot

Mr. Stumbles: "My vision hasn't been the same since I fell. Really blurry."

Dr. Grumpy: "Did you hit your head?"

Mr. Stumbles: "No, but I broke my glasses."

While you're waiting for the doctor...

Dr. Grumpy: "Okay, we'll see what the test shows... Any questions?"

Mrs. Lipstick: "You have some unused space in your lobby."

Dr. Grumpy: "Oh, that depends on the day, and how many patients Pissy and I have."

Mrs. Lipstick: "I was thinking I could put a small table at the far end."

Dr. Grumpy: "For what?"

Mrs. Lipstick: "I sell Avon cosmetics, and could set up a small store out there. I think a lot of your female patients would appreciate the convenience."

Dr. Grumpy: "What? No. I'm sorry, but that's just not something we'd like here."

Mrs. Lipstick: "How much of a commission do you want? I'm sure we can make a deal."

Small talk

Dr. Grumpy: "How's your husband doing?"

Mrs. Latrine: "He eats, then he shits. It's like living with a goose."

Dr. Grumpy's book club

Today I'd like to review a few books I've enjoyed.

Disclaimer: I am not being paid to write this, nor am I related to any of the authors. I'm also not selling the books on Amazon (though am thinking of trying to unload Frank's Pokemon guides there if he doesn't get them out of the living room).

The first is a new novel written by the totally awesome Fizzy (writing as Freida McFadden), purveyor of high-quality medical cartoons. I am, I must admit, somewhat jealous. Writing a book about the insanity of my practice was always on my to-do list, but as the years went by it became pretty obvious that I'd never have time to do it. So the book became my blog, and is a work in progress until I hang it up.

Anyway, Fizzy wrote The Devil Wears Scrubs. (Available from Amazon here). It details what is likely the most terrifying part of a medical career: the first 1-2 months of residency. Yes, you may have the title "doctor," but that doesn't mean you have a clue as to what's going on. Far from it. And you are more terrified than you have ever been in your life.

The tribulations are familiar to anyone who's done a medical internship: malignant senior residents, brown-nosing co-interns, eccentric attendings, nurses that run the gamut from supportive to hostile, and, in her case, a psychotic roommate (the last didn't apply to me, as I lived alone). Other things she learns to deal with (which are still big issues as an attending on call) are desperately trying to find time to pee, grabbing something to eat before you die or the cafeteria closes, and getting 10-15 minutes of sleep every 24 hours.

I found it to be an accurate, and funny, portrayal of intern life (except I wasn't dating a hunky surgeon).

The second book I read a few years back, but have always meant to write about. Although written by a doctor, it has nothing to do with medicine.

It's by Dr. Doreen Orion, and is a true story called Queen of the Road. She and her husband, both psychiatrists, gave up their practices for a year and bought a bus to drive around the continental U.S. (and a little of Canada) with a dog and 2 cats. The book is an entertaining combination of travel adventures, humor, and personal observations, as well as commentary on shoes, unusual local attractions, a bitchy GPS system, and, at one point, a nudist colony (I SWEAR!). Dr. Orion and I also shared the same curiosity about frost heaves when we first saw a sign warning of them (she thought they were some sort of monster, I thought they were an illness induced from overeating ice cream).

I loved Dr. Orion's book. As a veteran of many North American road trips, as a kid, as a single guy, and now as a parent, I sympathize greatly with her musings and adventures.

The last book, of course, is the one I can never emphasize enough, especially to medical students and residents. It is the one I refer to as the Bible, and is written by my medical idol, Oscar London, M.D.

It's Kill as Few Patients as Possible, and is a collection of 57 essays. Brevity is the soul of wit, and in its few pages an aspiring physician will find a bounty of practical knowledge to use in a career. The book is a bit dated in some ways (drug reps no longer give away free pens), but it also has a certain retro charm. It is, for example only available in a format that the ancients called "paper." This connection, like the 2400 year-old Hippocratic Oath, helps tie us to the ancient physicians of yore. Those long-gone days when someone had to go find a huge copy of a PDR lying around a nursing station to look something up, use a Yellow Pages to find a pharmacy's number, and radiology images were printed on a silver-based substance called "film" (yeah, that was my residency).

Happy reading! It's a great use of your occipital cortex!

Huh?

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

Phone Lady: "Hi? What's your fax number? I want to make an appointment with Dr. Grumpy, and send him my records."

Mary: "It's 867-5309."

Phone Lady: "Great! What kind of doctor is he, anyway?"

Mary: "Uh, he's a neurologist."

Phone Lady: "Oh, never mind."

Weekend on call

DiaStat is an emergency anti-seizure medication in a liquid form, that's given rectally. It's for seizures that are hard to control. It's usually used when you're trying to avoid taking the patient to ER.

This holiday weekend, while on call, I was phoned by a lady who has a daughter with severe epilepsy. Her regular neurologist had already given the family a supply of DiaStat for emergencies.

So when they called to tell me the seizures were out of control, I had her mother give her a dose of DiaStat, without benefit. After I told her to give a 2nd dose, I got called again.


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

Mom Seizure: "Hi, I gave Lisa the 2nd dose like you told me to, then I gave a 3rd dose of DiaStat on my own, and she's still seizing."

Dr. Grumpy: "You're going to have to bring her to the ER, and I'll meet you there. I can't safely give her any more outpatient medication."

Mom Seizure: "I understand, but is there anything else you could do? We really don't want to take her to the hospital. Is there another medication? Or another way of giving DiaStat?"

Dr. Grumpy: "Nothing I'm comfortable with, she needs to get IV medication, and further testing, and..."

Pause

Dr. Grumpy: "What did you mean by "is there another way to give DiaStat?"

Mom Seizure: "Well, the instructions say to give it rectally. I could try doing that."

Pause

Dr. Grumpy: "What the... you haven't been giving it to her rectally?"

Mom Seizures: "No. I've been putting it in her ear."

Dr. Grumpy: "IN HER EAR???!!!!!!!"

Mom Seizure: "Well, since seizures start in the brain, I figured squirting it in her ear would get it there faster. I was afraid putting it in her rear end would be too far away from the brain."

Pause.

Dr. Grumpy: "You need to bring her to ER."

Lazy holiday post

Science marches on. And makes a mess!

Thank you, Tab!

Huh?

Cat-Vi was kind enough to send in this picture from a magazine:

 It raises a few points:

1. Eggs are not dairy products. Just because the grocery store sells them near the milk does not mean they come from cows. Or mammals in general (yes, I know monotremes lay eggs, but they aren't generally eaten).

2. Pie graphs are supposed to add up to 100%. Not 71%. Even if you're just showing the top 3, you still should have a 29% slice marked "other."

3. Your graph is flawed. It left out broccoli and cauliflower, which have a near-100% allergy rate among children.

 Thank you, Cat-Vi!

Quote of the day

Dr. Grumpy: "Any side effects with the medication?"

Mr. Colon: "Yeah, I'm constipated. I've been using Miralax, Sennakot, Colace, and some other stuff. You know how it goes. It takes a village to have a shit."

Skool nerse time

This is Mrs. Grumpy.

My, how did the Summer go by so quickly? Well here we are again, in the first week of school.

As always, I have the cherished task of sorting out the "medical information cards" you parents fill out. I'm sure in this day and age it could be done more effectively online, but apparently they tried that at another school last year, and the parents didn't bother. I guess the internet kiosk line at the bus station was too long.

So we're continuing with cards.

Since filling these things out is a surprisingly complex task for so many of you, I thought I'd offer a few pointers.

1. On the line where it says "name" write YOUR KID'S NAME. Not your name. Or his sister's name. Also, putting nicknames like "Raggy," "Dudette," and "Booger," while cute, do not help. Especially when you don't put on a last name. So, let's keep this in mind: Write your KID'S name, both first and last. Middle is optional, unless it's a name that ends in a Roman numeral (such as Harold Winthrop Higgleschweimer IV). Then it's required so the teachers know he's just killing time with school until he gets his inheritance.

2. On the line where it says "medications" please list any your kid is taking. Things your ex was taking at the time of conception that you believe explain junior's shitty math scores do not belong there. Nor am I looking for a list of EVERY FUCKING PILL BOTTLE IN THE HOUSE. Just what junior is presently on, not what he might get into because of crappy supervision by your baby-daddy's 9 year old watching him and playing Nintendo simultaneously.

3. Under allergies, please write your kid's allergies. That's all. How hard is that? Peanuts? Check. Penicillin? Good, you've got the point. So stop putting stuff in like "soap from a Motel 6," "the sunscreen my MIL bought," and (my favorite this year) "Disney backpacks."

4. I need a phone number where I can reach you in an emergency. 911 doesn't count, unless you work there. And even then, it's a stretch. Likewise, telling me that it changes from week-to-week doesn't help, and makes me wonder if CPS should be called.

5. A vaccination record is really helpful. Writing "I believe in Jenny McCarthy" doesn't make me think highly of you. But my REAL pet peeve here is those of you who are simply too damn lazy to actually look for the records, and just scribble "religious reasons" to save time in filling it out. If that many of you hadn't vaccinated your kids, most would be dead by now. I don't believe you, so get off your ass and look through the filing cabinet.

6. If junior takes pills, please bring them in a labeled prescription bottle. A plastic baggie that says "Give a blue pill to Joanie once a day" isn't helpful. Nor is dumping a handful of loose unidentifiable pills on the counter and mumbling "those are for Steve" as you rush out with a phone glued to your ear.

7. I am not the NSA. I am not trying to violate your privacy here. I really do need to know if your kid has epilepsy. Or diabetes. Or asthma. This is knowledge that can make the difference between Billy living or dying when he's brought to my office sick as shit. Writing "none of your business" or "PRIVATE!!!" on the medical history section doesn't make my job easier. If you're writing it because you're too lazy to call your ex and ask about medical history, grow a pair and and do it. This is about your kid, not you.

Have a great school year!

For more skool nerse stories, please see my page.

Pop quiz!

Time for another contest, class:

These gadgets were in an MRI-supply catalog that (for unknown reasons) showed up at my office. So let's forget I told you that.

Take out your #2 pencils, and try to come up with some creative answers as to what they might be. I've already started you off with three ideas. 

These items are:





A. The latest in BDSM equipment.

B. Props from the next Hannibal Lecter movie.

C. Um... stuff used in a new Olympic sport? From, uh, that country over on that other continent?

Kid quote of the night

"Dad, you can tell this book takes place in the olden days, because the girl has a tape recorder."

Thanks, Marie.

Mary's desk, August 26, 2013

Mr. Stapes: "Hello?"

Mary: "Hi, Mr. Stapes. It's Mary at Dr. Grumpy's office."

Mr. Stapes: "Can you speak up?"

Mary: "HI, MR. STAPES. IT'S MARY, AT DR. GRUMPY'S OFFICE."

Mr. Stapes: "Oh, hi, Mary. Wasn't I just there a short while ago?"

Mary: "Yes. I'm calling because you left your hearing aids in Dr. Grumpy's exam room."

Mr. Stapes: "What?"

Mary: "YOU LEFT YOUR HEARING AIDS IN DR. GRUMPY'S EXAM ROOM."

Mr. Stapes: "I'm sorry, I have to hand the phone to my wife. I can't find my hearing aids."

Sunday night

 

My cell phone rings.

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

Dr. Nerve: "Hi, Ibee" (pant, pant, pant, loud thumping noise) "I'm just calling to give you the post-call check-out" (thump, thump, thump) "In room 752 is the guy you saw Friday..."

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

Dr. Nerve: "I'm running" (pant, pant, thump, thump, thump) "on my treadmill."

Dr. Grumpy: "Why don't you call me later? I can barely hear you."

Dr. Nerve: "No! (pant, thump) "I'm determined to get back in shape!" (pant, thump, pant, thump) "Anyway, the guy in 752, Mr. Smith, had another seizure last night..." (pant, pant, thump...)

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

Dr. Nerve: (thump, pant) "Hang on, let me get the list. I set it next to..." (thump) "AAAAAAAHHH!" (crash, thud) "SHIT!!!

click

Found in a shopping cart at Local Grocery

Patient quote of the day

"Why do I have to let you know whenever I have a seizure? You're not my fucking mother."

More survey fun

I've put up some of the weird/stupid/random questions I've seen on surveys in the past. Apparently these aren't limited to North America.

A reader from the other side of the planet (Australia) sent this excerpt from one he recently took:

It's the 4th item down that grabs my attention.

Let's face it: everyone has their own degree of what is and isn't comfortable. But if I've reached a point in my life where I'm having an autopsy, I'm pretty sure I'm not going to care one way or the other.

Thank you, Caillin!