Hawaiian vacation, day 3

Due to requests that I re-start my vacation series, I now present my summary of our trip to the islands. For those who haven't read my past vacation archives, they can be found here.
 

We had a pretty spectacular view of the ocean, overlooking the island of Lanai in the distance:

Nice, huh? I sat out there a lot, drinking beer & mai-tais and reading CME. Doing work-related stuff isn't so bad when ETOH and a great view are in the mix.

Watching birds all over the balcony (they're on the lookout for PBJ crumbs) gives you pause to realize that these are the last of the therapods - the biological line that once included the mighty Tyrannosaurus Rex. Sue must be spinning in her display case to see her descendents trying to steal french fries.

The view is interesting. The town of Lahaina is known primarily for its history as a major whaling center, but forgotten in there is more modern stuff.

The view above, toward the island of Lanai, is over a body of water called Lahaina Roads. This is actually one of the world's best sheltered deep water anchorages, surrounded by 4 islands (Maui, Molokai, Lanai, and Kahoolawe). In the years prior to, and during, World War II, the U.S. navy used it as a back-up base to Pearl Harbor. Ships that needed repairs or supplies went to Pearl, while those that were ready and just awaiting orders anchored in Lahaina Roads.

This was such a common practice that, during the Pearl Harbor attack, Japanese planes and a submarine scouted Lahaina Roads to see if there were any major American ships there, so they could redirect a squadron to attack them, too. There weren't any that morning (purely by chance) which was lucky for the Americans. Lahaina Roads is a few hundred feet deep, and ships sunk there would have been beyond recovery, while at Pearl Harbor most were raised and repaired.

Here's some pics of the same view, 70-80 years ago.

Cruisers, destroyers, and the carriers Wasp, Saratoga, and Lexington

U.S.S. Lexington

Lexington, 3 battleships, and some freighters

Lexington & Saratoga at center, 5 battleships at right, scattered cruisers & destroyers

I look out over it, and imagine the same view in early 1944, when carriers were stopped there on the way from the west coast to the front, and imagine this peaceful sea completely filled with warships being prepared for battle.


Hard to believe.

Hawaiian vacation, day 2

Due to requests that I re-start my vacation series, I now present my summary of our trip to the islands. For those who haven't read my past vacation archives, they can be found here.


So we got to our condo. It was tastefully decorated, with this lovely piece of art being the first thing you see on walking in:

Nothing really says "welcome to Hawaii" like a papier-mâché parrot in a faux-bamboo cage hanging from the ceiling (parrots aren't even native here. But, then again, neither are pineapples*). The kids immediately adopted it as their pet, since Mello and Snowball were back home. Craig, for reasons known only to him, named it Cassandra, and all 3 of them spoke to it frequently for the next 2 weeks. Cassandra, for her part, spent the entire time pining for the fjords.

Our bedroom had a similarly psittacine theme, with the night table lamps being equally tasteful:

"Say goodnight, Polly"

I can only assume the person who decorated our condo is a bird lover (or Jimmy Buffett fan), and not the owner of a pick-up truck we walked past.

Chicken choking, on the other hand, IS a crime. At least in some states.

Driving around the area we passed a nearby ABC store. For those who have never been to Hawaii, this is the universal corner store here, selling typical convenience store stuff, $5 T-shirts, and assorted tourist tchotchke. This one also had a couple gas pumps outside... But what really caught my eye was the large banner in front that said "Prime Rib Special, $11.99 Sunday and Thursday." While convenience stores are ubiquitous across North America, this is the first time I'd ever seen one advertising that.

Later in the afternoon we went to get snorkel gear for the trip, and I texted my Mom to see if she wanted to come with. She wasn't able to, as she was apparently fascinated by all the modern technological marvels found in her condo.

And that's the way it is.


*Really. They aren't. They're originally from the Brazil-Paraguay border region in South America.

Hawaiian vacation, day 1

Due to requests that I re-start my vacation series, I now present my summary of our trip to the islands. For those who haven't read my past vacation archives, they can be found here.


Our trip got off to a wild start with Craig.

Craig HATES flying. In the days leading up to the trip he became increasingly worked-up about going, and convinced himself that we were going to have a horrible time (no, he's never been to Hawaii before).

This reached a comical highlight the night before we left. Mrs. Grumpy sent me to get some extra socks for the kids, and so I went to his room. He was on the phone with a teen-crisis hotline, hysterical about going on the family vacation.

One can only imagine the thoughts going through the mind of the crisis volunteer on the other end. I imagine all the issues she'd heard that day:

"My stepfather is sexually abusing me."

"Mom won't stop drinking, and my Dad left us."

"My parents are taking me to Hawaii."

By nature of this job I'm pretty good at keeping a straight face. But I likely would have had to mute the line if I were the one dealing with Craig's call.

Of course, once we got to the airport he was fine, worried only about his hair.

Mrs. Grumpy and my mom took the kids to the overpriced McD's for breakfast, and I sat down at the gate to get some work done. I try to ignore others at airports and on planes. Don't talk to me, I won't talk to you, and we'll be fine.

Unfortunately, many disagree with this view. No sooner had I sat down and started work on some CME than a lady plopped down next to me, tapped me on the shoulder, and screamed "Can you believe this is all the hummus they give you for $8?"

I looked at the styrofoam container she was waving around, and tried to discourage her by saying "mmmph" and turning back to my reading.  That only led her to believe I was deaf, mute, or both. So she stuck the thing under my nose and said "SERIOUSLY!!! THIS WAS $8! ISN'T THAT AN OUTRAGE?"

Failing to get my attention, she moved to a guy in a business suit, who pretended to be on a phone call. Then she went over to bug some family, who told her to go complain at the food place. She then left the gate area, making me wonder if the whole thing was a TSA test of some sort.

A few minutes elapsed. Then a guy in a business suit sat down on my other side, whipped out a phone, and immediately began talking loudly into it with phrases like "Did you talk to the senator?", "I have meetings with senators all week. This is a MAJOR national issue," and "You need to realize how much money is involved at this level. It's very serious." He kept this up until he realized no one around was staring at him, so he left the gate, too. Hopefully someone catches him and re-starts his medication.

Mercifully, Mrs. Grumpy and the kids returned, scaring off other attention-seekers with some I'm more familiar with.

Our flight was delayed because an overhead bin had a faulty lock, and wouldn't stay closed. We watched as 2-3 different techs got on the plane, tried to fix it, got out a greasy maintenance book, argued about which screw was the problem, and then finally left to find a different type of screwdriver. While they were off the plane some guy in a "Binford Tools" t-shirt got out of his seat, slammed it closed, and punched the lock with his bare hand. When the tech guys came back it was working fine, and we got to take off.

At one point during the flight Craig got up to go brush his hair in the bathroom, so I went to to get something out of my carry-on. I noticed this suitcase in the bin. I'm not sure if the suitcase is inoperable, or the medical equipment, or both. And if the medical equipment is inoperable, why is it being flown around? Or even left on the plane, for that matter?

While I didn't bother with the in-flight entertainment, I did look up at one point to see an excerpt from a television show with 3 guys pairing beers with different varieties of Rocky Mountain Oysters. I guess it beats combining them into 1 beverage.


The best part about the Maui airport is that even the restroom signs are on vacation:

Because, if there's anything more relaxing than a laid-back bathroom stick-figure, I don't know what it is.

Kahului airport here is conveniently located next to a Costco. This, I suspect, is probably the busiest Costco in the world, as it's constantly packed with people who just got off planes and are there to stock up on Diet Coke, bagels, beer, and other essential vitamins & minerals. And, of course, to have lunch after your flight. Because the lady bitching about hummus at the airport has nothing on the people who just shelled out $9.50 for a bag of nuts during the flight.

Thursday afternoon

"I have headaches all the time. Even when I don't have a headache, I know I'm secretly having one."

Skool Nerse time

This is Mrs. Grumpy.

School is starting soon, and, as your school nurse, I'd like to offer some tips to help make this a better year for all of us.

1. I'm happy to handle your child's medications. That's part of what I do. Please be sure to bring them in with useful instructions. DO NOT drop them off outside my office door after I've left, or hang them in a grocery bag on the school's front gate overnight. Have you people seen the kind of neighborhood Douglas C. Kenney Elementary school is in? Billy's bottle of Adderall is worth a lot of money here, and likely made some junkie very happy. Can't imagine how you explained that to your pediatrician.

2. Where it says "Allergies" on the form, writing "yes," "sometimes," or "depends" doesn't give me much useful information. Please be sure to include details, like what Sara is allergic to (unless she really is allergic to Depends).

3. Writing movies you don't want your kids seeing is not what the forms are for. Talk to the teacher. I understand, as I'm sick of the music from "Frozen," too, but I'm not the person who deals with this.

4. Some of your kids know my kids. Fine. As a result, they know my kid's cell phone numbers. That's fine, too. BUT my kids are NOT a reliable way to pass messages to me in my capacity as the school nurse. Hell, they aren't a reliable way to pass messages AT ALL. Having your kid text my kid something like "Lacey has a fever of 104 and rash, can she still come to school?" or "Please have Phil in your office at 8:15 so I can take him to the dentist" should not be relayed through my kids. Stop it. I have a direct line and emails. They're on the school's website.

5. Calling the above number is not going to get you an appointment with my husband. Depending on how badly you piss me off when trying, the opposite might occur.

6. Although I said this before, I need to emphasize it. DO NOT claim to be part of Jenny McCarthy's Army just because you're too damn lazy to get me your kids vaccination records. If as many of you were anti-vaccine as claim to be, you wouldn't be alive.

7. On the form where it asks who's allowed to pick up your kids "anyone I send" is not an acceptable answer.

8. Writing "Do not allow wasps or bees to sting Evan" will not prevent them from doing so. Please address such requests to the Apocritae. I will only show it around the office, and we will laugh at you.

9. I keep "emergency" clothes up here for accidents. This is not the charity shopping mall. Do not send your kids in to "see if there's anything good."

10. No matter what you put on the form, there is absolutely no medical reason for a 7 year old to be carrying a cigarette lighter to school. Don't argue with me.


Thank you! Everyone have a great year!

Sigh

Dr. Grumpy: "So, how are you doing with the new medication?"

Mr. Noventa: "It's awful! It isn't helping my symptoms, and hurts my stomach. It also makes me sleepy all the time, I can't concentrate, and I think it's thinning my hair."

Dr. Grumpy: "Okay, then why don't you stop it, and we'll try switching you to..."

Mr. Noventa: "I'd rather continue it, because I just bought a 90 day supply."

Smokin'

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

Mr. Cheech: "Hi, I need to make an appointment with Dr. Grumpy."

Mary: "Okay, we can see you on..."

Mr. Cheech: "I don't have insurance. Does he accept other forms of payment?"

Mary: "Well, we take MasterCard, Visa, AMEX..."

Mr. Cheech: "No, I mean, like, in trade? I grow pot in my shed, and can give you some buds."

Mary: "No, we don't accept payment of that sort."

Mr. Cheech: "It's really high quality, organic. I don't use pesticides or any of that shit."

Gratitude

Dear Mrs. Patient,

I'm glad you're feeling better. It was nice of you to send me a thank you card. I actually treasure notes like yours, and keep them in (as my friend Amanda Brown calls it) the "I don't suck box." On really bad days I read stuff from it for solace, and to reassure myself that I really am doing my best, and some people appreciate that.

BUT I must admit, none of the notes I've previously received, in 15 years of doing this, came on a card with a picture quite like yours:

Run, Run, Away

All right, gang. With only a few weeks left before the kids head back to school, it's time for the annual Grumpy family Summer vacation. So we're loading up the minivan and adding pontoons for a 5000 mile drive.

I may post infrequently over the next 2 weeks, as time allows, but will return to my regular schedule in 2 weeks.

Major

Dr. Grumpy: "Any other major health issues?"

Mr. Durante: "I sneeze once a day, sometimes twice."

Memories...

It was the early 1970's. I don't remember the man's name. Maybe I never knew it.

My Dad didn't know it either, but he helped him.

Dad was downtown, driving home from his law practice one afternoon. I don't remember the time of year.

He was stopped at a red light while people crossed in front of his car. One was an elderly man with a cane. One of his legs was shorter than the other, and so he had a shoe with a platform bottom on that side to support him.

As he hobbled across the street, he tripped and fell, landing on his chest. The cane went flying, and he was unable to get back up. While he struggled to get to his feet the typical rush hour traffic began honking and yelling at him.

Dad got out, and helped the man up. The cane was gone, smashed by a car trying to beat the yellow light. He got the man to his feet, but without the cane he couldn't walk. So Dad put an arm around the elderly stranger, and got him to his car. He put him in the passenger seat, figuring then he'd find out where he lived and drive him home.

The man was scared, and badly shaken up. A stranger had just run out in front of traffic and yelling people to help him. And now my Dad learned he didn't speak a word of English - just Italian.

Nowadays maybe people would have left the man lying there, called police on their call phone, and driven around him. Or helped him to the edge of the curb and left him there for someone else to find. Or just not given a shit at all and continued honking at him.

But Dad brought him back to our house.

There was no cell phone. The first hint we had that anything was up was when Dad came in the carport door, supporting an elderly man I'd never seen before. He called my Mom, and as he explained what happened they got him to a chair at the kitchen table. Mom got him some water and a few band-aids for his bumps and scrapes.

Dad went to the phone. A friend of his was a doctor, whose father was an Italian immigrant. He reached him at his office as he was finishing up for the day, and the good doctor immediately called his father (who was fluent in both English and Italian) and they came to our house.

While the doctor checked him over, his father spoke to the man, and they quickly got his information. He didn't know the phone number of the building he lived at, but knew the address. It was a few miles from where he'd fallen, and he'd been on his way to the bus stop to go home when the accident happened.

The doctor's father drove the man home a short while later, though they stopped at the drugstore for a new cane.

I never saw the man again, but the memory is still there. A frail looking elderly man in a black suit, white shirt, and dark Homburg hat. The one shoe with the platform bottom. Sitting at the formica table in our yellow 70's kitchen.

I don't recall my Dad mentioning the events of that day again. I don't think I even remember him talking to me directly about it while it was going on. But I learned a lot that day that I hope I never forget.

Annie's desk

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

Mr. Blood: "Hi, I have a question about the labs Dr. Grumpy ordered."

Annie: "Sure, what's up?"

Mr. Blood: "It says here the labs are fasting."

Annie: "Yeah, that's standard for what he wants done."

Mr. Blood: "Okay, but am I the one who has to be fasting? Or is it the tech who draws them?"

Glad they cleared that up

Last night I was at a meeting about an upcoming drug study, and this was one of the slides:

I wanted to ask what they consider REALLY serious.

Words

On call yesterday I was in ER, examining a lady who'd just had a seizure. From the other side of the curtain I hear this:


Her: "Did you cover it? I don't want to catch diseases."

Him: "Yes. Now I'm going to put it in."

Her: "Please be gentle. I'm very sensitive there."

Him: "Of course."

Her: "Is it in yet?"

Him: "Just a little bit, I need to put it in further."

Her: "Ow! Don't push so hard!"

Him: "Sorry... It's in now."

Her: "I can feel it."

Him: "And... I'm done. I pulled it out. That wasn't so bad, was it?"

Her: "Only when you first put it in, but it went fast."


And it was... A male nurse checking a tympanic temperature on an elderly lady.

Sigh

Mrs. Seven: "I also take Spazon-XR."

Dr. Grumpy (looking at her list): "You take that just once a week?"

Mrs. Seven: "No, it's every Saturday."

Looking for clues

Mr. Construction: "My hands have been getting numb over the last few years."

Dr. Grumpy: "Any change in your activities in that time?"

Mr. Construction: "Nope. Same old boring job."

Dr. Grumpy: "Is there..."

Mr. Construction: "I hope you can figure this out, doc. It makes it hard to hold a jackhammer all day."

On the road again

(Guy walks in, stands at counter)

Mary: "Hi, can I help you?"

Mr. Distance: "I was referred to see Dr. Grumpy." (pulls out piece of paper, hands it to her)

Mary: "Okay, I can make an appointment for you. How about..."

Mr. Distance: "You mean you can't see me NOW?"

Mary: "No, today is full, but on Tuesday we have..."

Mr. Distance: "But I just drove over 200 miles to get here! You can see from the referral that I live in Waywest!"

Mary: "I'm sorry, but..."

Mr. Distance: "I saw Dr. Referral this morning, and she said that I should see Dr. Grumpy. So I decided to just come on over."

Mary: "Why didn't you call for an appointment?"

Mr. Distance: "I thought that would complicate things. Hey, can I use your bathroom?"

Clarification

I'm not sure what these guys want. Can anyone out there help me? They're pretty vague.

Thank you, Nos!

Hey, it's all your insurance will cover

Great medical ads:




Thank you, Jillian!

Thursday afternoon

Dr. Grumpy: "Are you allergic to anything?"

Mr. Anaerobe: "Chlorophyll, and all other oxygen producing substances."

Kissing up

About a month ago I had a pre-med student spend an afternoon with me. Actually, it wasn't even that. After 2 hours she looked liked she was bored out of her mind (I'd warned her about that, but she still wanted to come in) and left at 3:00, saying she was meeting a friend for lunch.

Anyway, I didn't hear from her again until yesterday, when this neatly typed note showed up in the mail:

Dear Dr. Grumpy,

Thank you for taking the time and allowing me to shadow you last month. I understand that having me there required a tremendous amount of time and effort, and I genuinely appreciate your support. My time with you was an unparallelled pleasure.

You are a great leader, humanitarian, and physician. I will always cherish the knowledge that you shared with me.

Yours truly,

Katie Brownnose



Dear Katie,

Thank you for your kind note. I'm sorry I wasn't able to keep you awake during your brief time here, but I warned you that office neurology, to an outsider, is less than exciting.

I'm glad you wrote, because I've been meaning to get in touch with you. Based on our brief time together I'm concerned you may have narcolepsy, and suggest you see a sleep specialist. If it would be easier, try to spend time with one (like you did with me) and they'll likely notice.

Thank you for your kind words. I've always considered myself a great leader here in my practice, but given that I'm solo this is easy. The real truth, though, is that Mary and Annie are in charge, and I just do what they tell me. If you become a doctor, you'll figure that out at some point.

I'm assuming that someday you'll hit me up for a letter of recommendation. Based on my interaction with you, I can certainly reassure them that you're neatly dressed, speak English when wide awake, and have 4 limbs, 1 head, and 2 eyes.

Yours truly,

Ibee Grumpy, M.D.


Actually, folks, I understand her note. I wrote my share of similar stuff back in the day, and now I realize even more so how awful it sounded.

My staff is awesome

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

Mrs. Memory: "Hi, I need to come back and see Dr. Grumpy."

Mary: "Um... Actually, you have an appointment today, at 1:45."

Mrs. Memory: "No I don't."

Mary: "You do, ma'am."

Mrs. Memory: "I most certainly do not. Otherwise I wouldn't be calling you. Now, as I was saying, I need to see Dr. Grumpy again."

Mary: "Okay, well, if you'd like to come in today we have an opening at 1:45?"

Mrs. Memory: "Oh, that works perfectly. I'll be there."

Mary: "Great! See you then."

Mrs. Memory: "Thank you for getting me in so quickly."

Dear Azilect,

Recently, one of my patients applied to your Azilect assistance program, to help those unable to afford a prescription for it.

She filled out the papers, got them together with her Azilect prescription and financial info, and I signed the forms and put them in the mail.

So, I was somewhat puzzled when she brought in this letter last week:

What's up with this? I mean, if the Azilect Patient Assistance Program DOESN'T provide Azilect, what do they provide? Oven mitts?

For future clarification you should consider renaming the program "Non-Assistance" or "No-Azilect Program."

Or, simply have it supply Azilect in the first place.

Yours truly,

Ibee Grumpy, M.D.

From the slushpile

Okay, it's time to hit the mailbag for more examples of artisan/artisanal junk you guys have sent in.

Again, this is not to make fun of tradesman who are genuinely working on handmade artisanal products. This is to highlight, as I have before, the many bullshit uses of the word being slapped on pretty much anything that's mass-produced, or grown (if it grows on a tree, you didn't make it), or other abuses of the word.

First, we have this:

I mean, it's SEAWEED for crap's sake. It grows in the ocean and washes up on the beach, making a rotten, smelly, mess. How is that artisanal?



What else is artisanal these days? Maybe something made in small quantities... Like hot dogs and their fluffy buns:

I'm pretty sure ANYTHING advertised on a roadside billboard isn't artisanal.

What about the security guard who drives around your neighborhood looking for suspicious characters, and calls your house when you set off the alarm while putting out the dog? Is he an artisan? Apparently so.

"So, Mr. Zimmerman. You say you're an artisan?"

Hopefully, having a good artisanal security system will bring you some peace of mind. But, if it doesn't I suppose you can always go buy it:

"Handcrafted tranquility is in aisle 4. Do you have a note from your doctor for that?"

Speaking of peace, have you been trying to find a nice place for Grandma? How about...

"What does artisanal mean? What does artisanal mean? What does..."

And, lastly, while the overuse of "artisan" certainly brings an uncertainty principle of what it means, I still have to respect it when it's tied to a good joke.

"Hey, what's this blue candy inside my baguette?"

Nigel? Is that you?

Back when my kids were younger, they loved the Toy Story stuff. Including the Evil Emperor Zurg:

So, it's no surprise that Frank had to have the Zurg Blaster gun, which fired green ping-pong balls.

Anyway, they're beyond that now, so recently we were getting together some old toys to donate to charity. On the side of the Zurg Blaster, I noticed this:

How awesome is that?

If you don't get it... I feel sorry for you.

Nitrogen, CO2, you name it.

Dr. Grumpy: "Let me get an MRI form... Are you claustrophobic?"

Mr. Lung: "No, but I need to breathe during the test. There's air and oxygen and all for me in there, right?"

Modern crime

More valuable than gold. Rarer than platinum. More coveted than oil. Yes, the most prized substance on Earth is clearly...

Shortbread.

Yeah, you read that correctly.

I didn't think so either, but I'm not much of a shortbread fan. Honestly, I had no idea it was so valuable, until this morning.

This past weekend a daring group of Scottish thieves, in what would have easily been a crime to rival anything in Agatha Christie's works, attempted to steal £15,000 (that's $26,000, folks) worth of shortbread.

That better be some damn good baking. I mean, why the fuck would you steal shortbread? I'm pretty sure these 4 guys weren't planning on eating it (they'd have to be pretty hungry). Is there a huge black market for shortbread in Scotland? While I've encountered my share of seedy characters around my downtown office here in the states, I don't recall anyone in an alley saying "Pssst! You want to buy some shortbread?" and showing the inside of a jacket with cookies hanging off it.

Granted, I suppose it could have gold or diamonds in it, or be a baking operation as a front for Walter White, but... probably not.

Anyway. So, a bunch of guys stole a truck full of shortbread. Thankfully for civilization, however, their dastardly plot was foiled.* Not by Hercule Poirot or James Bond or Scotland Yard, either.

Their attempt to drive the stolen goods away failed because, instead of filling the fuel tank with the recommended diesel (they should have read the owner's manual) they used cleaning fluid.

Really.

How you get Windex mixed up with petroleum derivatives is beyond me, but they did. And thank heavens for it, or the economies of western Europe might have collapsed due to the shortbread shortage. Not only that, it probably saved these guys from dying while having cookies and diesel fuel that they mistook for milk.

Thank you, Webhill!

*The original article used the word "scuppered." That's a great word. Why can't American news outlets use cool words like that?

Memories...

Dr. Balboa was a cardiologist at my medical school. He was good at what he did.

Unfortunately, he also had a confrontational personality, short temper, and complete inability to back down from conflict. These are not good traits to have when you're just over 5 feet tall, slender, and have absolutely no training in Karate/Kung Fu/Krav Maga/whatever.

So, on a relatively frequent basis, the hospital ER docs were used to sewing him up for injuries sustained in bar fights, traffic altercations, or any number of minor arguments that he escalated to stupid levels.

One night, during my 4th year cardiology rotation, I was also covering an ER shift for a friend who needed to trade. And, of course, Dr. Balboa came in. He'd been at a sports bar and the waitress accidentally knocked over his drink. Rather than accepting a replacement, he decided to hash it out with the bouncer. Which is never a good idea.

Since the inner-city ER was swamped, he was stuck with having me sew him up (or wait a few hours for a real doctor, or go to another ER). Hey, it wasn't something I wanted to do either, but I was stuck.

So, while I'm trying my best to professionally put in stitches, he began telling me what I was doing wrong, grilling me about the patients on our cardiology service, pimping me on side effects and half-lives of various drugs, and arguing with no one in particular about how today's medical students weren't as tough as they used to be. None of which helped keep me focused on the job at hand.

After he was discharged, I went back to the staff lounge to get some coffee. The window there looked over the parking lot. As I watched, Dr. Balboa went out to his BMW and began arguing with a guy who'd set a Gatorade bottle on its roof.

Five minutes later he was back in triage with a broken wrist.

Verbiage

Back in the early, sexist, 80's, I had a teacher who'd say "writing should be like a girl's skirt: long enough to cover the subject, short enough to keep it interesting."

Now, times and expressions may have changed, but his point is still well-taken. This was driven home to me recently while reading an article about the effects of concussions on college football players.

I'd have to say the gentleman on the right nailed it:

Sunday night call check out

Dr. Grumpy: "Next one, in room 734 is Mr. Spin, admitted for severe vertigo. I think it's peripheral, but ordered an MRI and..."

Dr. Nerve: "What kind of vertigo?"

Dr. Grumpy: "Positional vertigo. It happens when he turns his head left."

Dr. Nerve: "Which of the semicircular vestibular canals is involved?"

Dr. Grumpy: "Are you serious?"

Dr. Nerve: "Yes. Which canal is involved? Superior, Horizontal, or Posterior? They taught you that in residency, didn't they?'

Dr. Grumpy: "I have no fucking clue. I had 29 consults this weekend, and breaking that down isn't going to change my management."

Dr. Nerve: "I think these things are important."

Dr. Grumpy: "I don't when I'm swamped. On call my main question is whether it's central or peripheral. You want more than that, call an ENT."

Dr. Nerve: "Personally, I examine them closely until I've localized the canal."

Dr. Grumpy: "You do that. He's in 734. The MRI is pending. The next patient is..."

Erev Independence Day

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

Ms. Triptan: "Hi, I need to get in to see him tomorrow. My headaches have gotten worse."

Mary: "We're closed tomorrow. It's a holiday."

Ms. Triptan: "But this is important. I'm really miserable, and need something done! Couldn't he meet me there? Just for a short while?"

Mary: "No, but we had a cancellation for today, at 4:15. He can see you this afternoon."

Ms. Triptan: "I can't do that, I'm going to the casino. It's Bonus Slots Thursday."

Help wanted

You need to have brain surgery. Wouldn't you want a surgeon who had experience in the field (as opposed to, say, removing ingrown toenails)?

Me, too.

So, this is an interesting job ad. A hospital is looking for an anesthesiologist. That's the person in charge of making sure you're deeply out when they cut you open, watches your vital signs to make sure you're not dying on the table, and then (hopefully) wakes you up after the surgeon has put you back together.

So shouldn't they want someone who'd previously done that a few times?

Apparently not:

Yes folks, you read that correctly. They want an anesthesiologist, but experience using anesthetic drugs and procedures is "preferred" though not, say, "necessary" or "required" or "a really good idea."

Let's look at it this way:


Astronaut wanted to fly large rocket full of highly explosive fuel at 17,000 miles per hour to International Space Station. Experience at operating rockets preferred.

Scientist needed to calculate origins of matter and to evaluate data relating to Higgs Boson. Experience with physics preferred.

Person needed to maintain nuclear warheads. Experience with handling lethally radioactive materials with potential to wipe out a city preferred.


Now, realistically, I'm aware it would be hard to become a board certified/eligible anesthesiologist without actually doing the procedures and giving drugs... but you never know. I trained with a guy who got through a 3 month surgical rotation without ever setting foot in the OR. And he passed.


Thank you, Jess!

Full service neurology

I'm between patients when Mary tells me a doctor is on hold.


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

Dr. Veoli: "Hi, this is Al Veoli, the pulmonologist across the street. We have a mutual patient, Don Epazil, who you're seeing for memory problems?"

Dr. Grumpy: "What's up?"

Dr. Veoli: "I'm not sure what to do here. I guess he was going to haul his clothes to the cleaners, but got the addresses mixed up. He took the bus here, and now he's out in the waiting room, trying to give bags of dirty duds to my staff."

Dr. Grumpy: "I'm sorry. His son lives with him, but is out of town this week. Tell him to come over here. I'll call his sister, who's handling this stuff."

Dr. Veoli: "He's showing stains to people in my lobby asking how to get them out. One nice lady is trying to give him pointers. I don't think she realizes what she's dealing with."

Dr. Grumpy: "Okay. Direct him here, and I'll give his family a ring."

Dr. Veoli: "Thanks. Sorry to bother you."

10 minutes later

Mary: "Hey, doc, Mr. Epazil is up front with 3 bags of dirty clothes. He says he was supposed to bring them here to have them done? Laundry WAS NOT in my job description."

Perspective

My daughter left her hairbrush on the kitchen counter last night.

That's not a big deal, but when I first walked into the kitchen, this is what I saw:

Sunday night, 11:23 p.m.

The following message was left on my office voice mail last night:

"Hello, I'm a patient of Dr. Grumpy's. It's Sunday night, about twenty minutes after 11:00, and I'd like someone to call me back. Thank you."

That's all. Never called back with anything more helpful, like a name or phone number.

Random weekend pictures

All right, time to hit the e-mail bag of stuff you guys have sent in.


First, this was taken at an art museum in Budapest (it's actually the name of the artist being featured).

"On your right is the Sheriff Jim Clark display, and in the next hall are Ernst Zündel's works"

Next, we have this. Apparently telling someone to "go pick up paper towels" at the store is no longer enough. I had no idea the world needed this many varieties. I mean, IT'S A FUCKING PAPER TOWEL!!!

7 varieties of paper towels. For this we evolved from microbes.

Then there's this massage company, who probably should have thought out their logo a bit more carefully:

"The pun sucks, too."

Speaking of interesting signs, I have no idea what this means:

"The counter lady yelled at me. Maybe they mean bitches."

The box makes it sound like they sing, dance, and perform theater:

"I'm trying to eat, and my fork keeps doing the Macarena."

Next is an ad for a group that does bio-identical hormones. The name sounds like they're all clones.

"Did you want to see Dr. Grumpy, Dr. Grumpy, or Dr. Grumpy?"

And last, I have no idea why this company couldn't come up with a better way to say "non-allergic pet food"

"Which end of Fluffy do we put it in?"

Great Public Service Announcements

Whirrrrrrrrrrrrrrrrrrrr

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

Mrs. Sikorski: "You saw my daughter yesterday? I was at the appointment if you recall, and you started her on Migrazap?"

Dr. Grumpy: "Yes, I remember. Is there a problem with the medication?"

Mrs. Sikorski: "No. I'm calling because she drove back to college today, and I don't think she's getting enough sleep."

Dr. Grumpy: "Well, the medication won't affect sleep, so it..."

Mrs. Sikorski: "That's not the issue. I need you to call her and discuss how important sleep is, because it's going to affect her grades. She also needs to study more."

Dr. Grumpy: "Well, that's not really my place. I mean, she's 21 years old, and away at college, and..."

Mrs. Sikorski: "Could you at least bring it up at her appointment next month? Also, can you say a few words about her current boyfriend? I don't think he's good for her."

Annie's desk

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

Mr. Valproate: "I want to know why the doctor won't refill my seizure meds!"

Annie: "Let me see... I don't show that we have a request for that. Did you call your pharmacy?"

Mr. Valproate: "Yes! They told me they've sent it to Dr. Intern 3 times, and all she does is say that she doesn't prescribe my seizure meds. So why won't Dr. Grumpy refill it?"

Annie: "Why are they sending it to Dr. Intern? Did you ask them to fax it to Dr. Grumpy?"

Mr. Valproate: "No. Am I supposed to?"

Memories...

As readers know, my roommate for all 4 years of medical school was a guy named Enzyme.

Enzyme was about 6'3" and maybe 190 lbs. He was calm, cool, and confident, the perfect model of the U.S. Navy officer that he is today. Handsome and a ladies man. He knew how splendid he looked in his uniform. He loved the military, and didn't let anything alarm him.

Until one night.

It was, maybe, around 2:00 a.m. I'd gone to bed at midnight after giving up on studying for the day, and was in a deep sleep.

While I slumbered, deeply napping, suddenly there came a tapping, as of someone gently rapping, rapping at my bedroom door.

Med student Grumpy: "Hello?"

Enzyme: "Ibee, are you awake?"

Grumpy: "I am NOW. What's up?"

(silence)

Grumpy: "Are you okay?"

Enzyme: "I... Need your help."

Grumpy: "It's 2:00 a.m. What's going on?"

(silence)

Grumpy: "Enzyme?"

Enzyme: "There's a spider in my room."

Grumpy: "What?!!!"

Enzyme: "I said there's a spider in my room."

Grumpy: "What the hell? So squash it and let me sleep."

(silence)

Grumpy: "Hello?"

Enzyme: "I'm scared of spiders."

It wasn't even that big, FFS.

"Are you shitting me?"

Awesomeness

For those of you who don't follow Twitter, I'm going to have to put this up.

My random observation was good. But WhiteCoat's response made it great:

Senior citizens behaving badly

A "Neurology Update" sent out recently by MDlinx. Hazards of leaving the "T" out...

Thank you, Gene!

Postage stamps

While waiting in line at the post office yesterday, I saw this stamp in a machine:

I had a brief thought about trying trying to ask for one at the counter:

"I need a great sparkled fraternity. I mean, a freight spanked fickle lilly. No, wait, a crate mangled fritterfrilly. No? A great teutonic titterwilly? Trait-specific hereditary? Um... fate frazzled hillbilly? Razzle-dazzled pickled lorrie?

"Fuck it. I need a 70-cent stamp."

How not to get an appointment

Mary: "Okay, Mr. Suidae. Now, let me give you some forms... here's a clipboard, and a pen... I'll need to get a copy of your insurance card. Any questions?"

Mr. Suidae: "Yeah, will you go down on me?"


And no, folks, he had no neurological reason to act like that.

Beware of the Dragon

Seen in a vascular ultrasound:

"We're gonna need a really big ultrasound machine."

For non-medical readers: It should have said "left lower extremity."

Thank you, Homebru!

12:07 a.m.

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

Miss Myelin: "Hi, I'm a Multiple Sclerosis patient of yours, and I wanted you to know I'm in the emergency room. The doctor here is probably going to call you."

Dr. Grumpy: "Okay... Why did you go to ER?"

Miss Myelin: "I lost vision in my left eye. I didn't want to bother you, so I came right in. I was worried that I should get it checked out."

Dr. Grumpy: "Sounds like you did the right thing. Has the doctor seen you yet?"

Miss Myelin: "No, but they just got me back here."

Dr. Grumpy: "When did you lose vision in your eye?"

Miss Myelin: "About a month ago."

Dr. Grumpy: "A MONTH AGO? Why didn't you call me?!!!"

Miss Myelin: "Like I said, I didn't want to bother you."

Dr. Grumpy: "Did you start the MS medication, the Tyglatfiderexa, that I prescribed 2 months ago?"

Miss Myelin: "No. I don't know why you gave me that. I informed you at the first visit that I won't take narcotics."

Dr. Grumpy: "It's not a narcotic! I told you that. It's for your immune system. Who said it was a narcotic?"

Miss Myelin: "This lady I met."

Dr. Grumpy: "Is she a doctor?"

Miss Myelin: "No, she's the cashier at Qwik-Mart. But I think her boyfriend's dad is."

Back from the trenches

Frank and Craig returned yesterday from 10 days at Camp Befouled, where they did outdoors type stuff with other guys in the forests of northstate.

To the horror of all (except the boys) we discovered they were wearing the same clothes they'd left our home in 10 days earlier. And, on looking through their bags, we discovered no dirty clothes at all. Just neatly folded shirts, underwear, socks, etc. So they'd been wearing the same outfits, day and night, for 10 days.

They didn't seem to have a problem with this, but on the drive home Mrs. Grumpy and I sure did. In the high humidity of a hot day we had no choice but to keep the windows down so we wouldn't die. If I'd thought to bring some twine I might have just put them on the roof rack for the ride.

Upon getting home, even the dogs didn't want to get close to them. When you smell so awful your dog isn't interested... That's really bad.

We immediately directed them to the shower closest to the garage.

Weekend reruns

Dr. Unka is in my office building. When he refers a patient to me, he often walks them upstairs to my office and waits with them up front (while his own waiting room backs up) until Mary has scheduled the patient. He often asks that I drop everything I'm doing to come meet his new referral, instead of just, say, having them call us to make an appointment.

So today Mary grabbed me to say Dr. Unka was up front, and wanted me to come meet a new patient. So I excused myself from my current patient and went up front, to see him standing there with a familiar, somewhat irritated-looking, older lady.


Dr. Unka: "Ibee, I'd like you to meet Mrs. Ancient. I'm referring her for memory loss."

Dr. Grumpy: "Uh, I saw Mrs. Ancient 3 weeks ago for that."

Mrs. Ancient (glaring at Dr. Unka): "I told you! Why didn't you listen to me?"

Dr. Unka: "She did?"

Mrs. Ancient: "Yes!"

Dr. Grumpy: "Yes, I sent you a note."

Dr. Unka: "You did?"

Mrs. Ancient: "Yes! He did! It was even in my chart at your office! I pointed it out to you!"

Dr. Unka: "You did? Um, I mean, then have her make a follow-up." (leaves my office).


So, in this situation, who REALLY needs to be seeing the neurologist?

Thursday afternoon

Dr. Grumpy: "Hello, sir, I'm Dr. Grumpy. Have a seat... so what can I do for you?"

Mr. Thebaine: "My life is a never-ending orgy of pain and misery."

Ma-Ma-Ma Bell

 Mrs. Dementia lives with her daughter. She's on the ball enough to remember that she doesn't like me because I took away her driver's license, but that's about it. Anyway...


Mrs. Dementia: "Hello?"

Mary: "Hi, Mrs. Dementia. This is Mary, from Dr. Grumpy's office."

Mrs. Dementia: "Hi, Mary. You have the wrong number. I don't live here anymore."

Mary: "Okay, well, I'm calling to remind you about your appointment tomorrow."

Mrs. Dementia: "I won't be able to go. My daughter's car isn't working, and can't be fixed. I can't go to doctor appointments anymore."

Mary: "Is your daughter there?"

Mrs Dementia: "No, she drove to the grocery store because we're out of bread."

Mary: "Can you have her call me when she gets home?"

Mrs. Dementia: "She doesn't live here anymore, either. I don't know when she'll be home."

Mary: "Okay, I'll just call back later, thank you."

Mrs. Dementia: "You can't. Our phone is broken, and no one has been able to reach us for days."

Mary: "Does your daughter have her cell phone with her?"

Mrs. Dementia: "That's broken, too. I think you have a wrong number."

Mary: "Okay. Thank you. I'll try..."

Mrs. Dementia: "Our phone is broken, so don't try to call back. The grocery man told us it can't be fixed."

Daughter (picks up extension): "Hello? This is Sue. Mom, who are you talking to?"

Mrs. Dementia: "I'm sorry Sue, I think you also have a wrong number."

Mary: "This is Mary, at Dr. Grumpy's office."

Mrs. Dementia: "Our phone is broken, and we can't hear you."

Sue: "Hi, Mary. Is this about tomorrow?"

Mary: "Yes, at 2:45.

Sue: "We'll be there."

Mrs. Dementia: "You both have a wrong number because the phone is broken. I didn't hear it ring."

Mary: "Thank you. See you then."