Wednesday, August 17, 2016

Pinocchio

One of my patients was at the lab to have her blood drawn, and the lab called me to say that she could barely walk and kept falling. I had them send her to ER, and then went to see her.


Dr. Grumpy: "Your head CT was okay, but the seizure medication blood level was WAY too high. Have you been taking it correctly?"

Mrs. Ataxia: "Um... Well, this morning I took a triple dose."

Dr. Grumpy: "Why on Earth did you do that?"

Mrs. Ataxia: "Because I was going to get my blood level drawn, and didn't want you to think I hadn't been taking it."

Dr. Grumpy: "Had you been taking it?"

Mrs. Ataxia: "Yes."

Dr. Grumpy: "Really?"

Mrs. Ataxia: "Uh... maybe... here and there."

Dr. Grumpy: "Overdoing it just before you get the labs drawn won't make up for that."

Mrs. Ataxia: "Sometimes it works at the dentist's."

Monday, August 15, 2016

Skool Nerse Time

Another exciting school year will be starting soon, and somehow I got sucked into becoming a band booster. This thrilling job involves me handling questions from other parents about band, upcoming band camp, musical instrument rentals, over-the-counter medications, do you know a good plumber, next week's weather forecast, and why are you calling me because the judge said it's my ex who has to pay for this stuff.

In a week of calls, this one was my favorite:


My iPhone rings.

Nurse Grumpy: "Hello, this is band booster Grumpy."

Mrs. Clueless: "I just found out my daughter, Marsha, has to bring her musical instrument to band camp?"

Nurse Grumpy: "Uh, that's correct."

Mrs. Clueless: "Why didn't anyone tell me this? You need to make these things clear!"

Nurse Grumpy: "Well, it is band camp."

Mrs. Clueless: "On that whole list of things to bring to camp, no where did it say 'musical instrument.' "

Nurse Grumpy: "She does need to bring it."

Mrs. Clueless: "What kind of instrument should she bring, anyway?"

Nurse Grumpy: "Um, whatever she plays. What does she play?"

Mrs. Clueless: "YOU'RE THE BAND BOOSTER! Isn't it your job to know that?"

Nurse Grumpy: "Okay... so you don't know what Marsha plays?"

Mrs. Clueless: "It's something she blows in. Where can I get one of those?"

Nurse Grumpy: "That covers a lot... What does it look like?"

Mrs. Clueless: "I don't know. It makes a lot of noise, so she has to practice with her door closed. I've never seen it. Can I rent one?"

Nurse Grumpy: "You don't have one?"

Mrs. Clueless: "Well, she has the screechy thing in her room. You mean I have get another one for her to take to band camp?"

Nurse Grumpy: "No. She can take the one she already has."

Mrs. Clueless: "Doesn't make that clear, either. This info sheet is useless."

Nurse Grumpy: "Just have her bring the instrument, whatever it is, that she has at home, to band camp."

Mrs. Clueless: "You people are really disorganized and unhelpful."





Friday, August 12, 2016

Fone Fun

The home phone rings.


Dr. Grumpy: “Hello?”

Accent Guy: “Hello, I am calling from Bank of Grumpyville technical support, and I need some information about…”

Dr. Grumpy: “I didn’t call technical support.”

Accent Guy: “Well, I am returning a call about a trouble ticket. I need your BofG…”

Dr. Grumpy: “Nurse Grumpy, did you call BofG technical support?”

Nurse Grumpy: “No.”

Dr. Grumpy: “Sorry, you must have a wrong number.”

Accent Guy: “Well, what we do is Windows technical support, so I guess there’s an issue with your Windows log-in for BofG. Can I have your computer…”

Dr. Grumpy: “No one here uses Windows.”

Accent Guy: “I’m sorry, did I say Windows? I meant it’s a Mac issue and I need your…”

 
As much as I felt like stringing him on for fun, I hung up.

Wednesday, August 10, 2016

Seen in a chart






"Are you shitting me?"

Thank you, ERM!

Monday, August 8, 2016

Another fun weekend

With all respect to Bob Seger.


On the long and lonesome highway
To the hospital
You can listen to your iPhone
Ringing with another call
You think about the differential
Of the case you saw the night before

But your thoughts will soon be wandering
The way they always do
When you've been awake for 27 hours
With consults still left to do
And you're sick of swilling coffee
You just wish the call was through

Here I am
Out on call again
There I am
On a rounding rampage
Here I go
Playin' doc again
There I go
Return the page

When you walk into the doctor's lounge
Strung out from Diet Coke
And the only food that's left in there
Is just a friggin' joke
So you take a half-eaten, stale, bagel
And try hard not to choke

They call to check the orders
"Hi, doctor this is Jan
In your note on Mr. Stroke
Did you want an MRI or CT scan?"
And at 2:00 a.m. you're there
Eating popcorn from a bedpan

Here I am
Out on call again
There I am
On a rounding rampage
Here I go
Playin' doc again
There I go
Return the page

Racing through the ER
The CT is 2 more halls away
And you've only got an hour left
To start the tPA
As the sweat pours out your body
"Please don't hemorrhage," you pray.

Later in the evening
As you lie awake in bed
With your cell phone like a live grenade
Lyin' near your head
You take another ER call
About a guy whose brain has bled

Here I am
Out on call again
There I am
Trapped in its cage
Here I go
Playin' doc again
There I go
Return the page.

Friday, August 5, 2016

Seen in a chart


Wednesday, August 3, 2016

Ashes to ashes, funk to funky

This summer we visited my in-laws, and one night they had a potluck in our honor.

Unfortunately, great aunt Frieda left a casserole at home, so I got volunteered to drive her down the block to get it. Craig came, too, as he was trying to avoid his cousins.

We walked into this small musty-smelling condo and were standing there while she rummaged in her fridge. Craig, trying to make conversation, asked “do you have any pets?”

Great aunt Frieda: “Yes, I have a cat, Marty.”

Craig: “Where is he?”

Great aunt Frieda: “Over there.”

And she pointed to a shelf above the stove. With a ceramic urn that said “Marty."

Monday, August 1, 2016

Theft

Mr. Ford came in for memory loss.

He drove himself to the first appointment with a friend's car, because his was in the shop. After the appointment he didn't remember that he had someone elses car, and walked all over the parking lot looking for his. He finally gave up, assumed his car had been stolen, and came back to my building for help.

He went to the cardiologist down the hall and told the receptionist his story. She called the police to report a stolen car. After interviewing Mr. Ford, the officer had him call a friend to come get him, but the one he called couldn't do so because Mr. Ford had his car, and couldn't make Mr. Ford understand that.

So the friend came in a cab to get my patient (who'd by now wandered back to my office). As they walked out to the friend's car, Mr. Ford said, "You know, I saw your car out there when I was looking for mine. I didn't know you had a doctor's appointment today, too.”

On Wednesday he called Mary to cancel an appointment for that day (which he didn’t have). He said he couldn’t come in because someone had stolen his car while he was at the doctor's 2 days ago. He later called in to see if he could get the appointment back, because the car had been “found” at a local repair shop (whose owner couldn’t figure out why it hadn’t been picked up for 5 days).

For the next 2 weeks we continued to get calls from Mr. Ford, asking if he could make an appointment now that he had his car back. He was politely reassured each time that he’d already been here.

I called and discussed things with his adult son, who took the car away while I notified the state about revoking his license. This only led to further (continuing to date) calls that someone has stolen his car. The local police aren't happy about this, either, and are now telling him to call me when he calls about the stolen car.

I can't say I blame them, either.

Friday, July 29, 2016

Random pictures

Okay, time to hit the mail bag for stuff you guys have sent in:


First is this book:


Mike writes in:

1. Is the guy at the top whacking off?

2. Isn't this sort-of racist?



Then we have this unusually comfortable looking external hard drive:






Another bad day for the photo-caption editor:




The name does not inspire confidence in this place's cleanliness:





This sign at Home Depot, which makes it sound like they're afraid of psychiatrists:




This car:




Jay says this sign is outside the orthopedic ward at her hospital:

"It's a total joint center, dude... totally."

Wednesday, July 27, 2016

Hospital rounds

Dr. Grumpy: "How are you doing?"

Ms. Dyspnea: "I don't like this oxygen mask. It hurts."

Dr. Grumpy: "Well, you need it to breathe. The other only other option would be to intubate you and have a machine do the breathing."

Ms. Dyspnea: "That's what the idiot nurse told me!"

Dr. Grumpy: "It's the truth. You need oxygen to keep going."

Ms. Dyspnea: "Bullshit. I asked the nurse if I could just get the oxygen in my IV, and she said she couldn't do that. We all know she could just take off this stupid mask and plug it into my IV instead."

Monday, July 25, 2016

1:47 a.m.

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

Ms. Phone: "Hi, this is Cindy Dingdong."

Dr. Grumpy: "Are you one of my patients?"

Ms. Phone: "No, I found your name on Google. I just moved here and have a sore throat. Can you call in some antibiotics?"

Thursday, July 21, 2016

Winning bid

Dr. Grumpy: "How's the diet going?"

Mrs. Atkins: "It's on hold. I ordered that diet book you suggested, but the person I bought it from on eBay screwed up."

Dr. Grumpy: "What happened?"

Mrs. Atkins: "They sent me this instead. I'm actually going to the post office to mail it back later."


She reached into her bag, took out a book, and held it up. It was called "Working with a Transsexual: A Guide for Coworkers."


Dr. Grumpy: "That's definitely not the diet book I recommended."

Mrs. Atkins: "No. And you just know someone out there was hoping to get this book to help them at work, and is instead staring at my diet book."

Monday, July 18, 2016

Sunday night check-out

Dr. Grumpy: "In room 734 is a guy with arm weakness since a shoulder injury. I've ordered an MRI of his brachial plexus."

Dr. Nerve: "Where do you think the problem is?"

Dr. Grumpy: "Uh, in the brachial plexus."

Dr. Nerve: "You should have made that clear."

Friday, July 15, 2016

When dogs fly

Me: "What kind of dog is she?"

Mrs. Owner: "She's a Morkie. It's a cross between a Yorkie and a, um, Maltese Falcon."

Wednesday, July 13, 2016

Follies

I saw a guy for headaches recently. Nothing unusual in his story, but, since he'd never had them before, I ordered a brain MRI. I figured, like most of them do, it would come back normal.

I wasn't even close. It came back, not just abnormal, but weird. All kinds of odd changes. Nothing easy to point a finger at, like a stroke or brain tumor. But definitely not normal.

Like I always do in these cases, I called the neuroradiologist who read it, and discussed the case. He was pretty certain of the strange findings. We reviewed all the different causes, and none of them fit with his history.

Because of the unusual nature of the findings, I got a copy of the MRI and took it to another neuroradiologist for a 2nd opinion. She absolutely agreed with the first guy.

So, I was stuck with something weird, not easily explainable for his case. After hospital rounds the next night I went to the hospital library, and spent some time looking up the findings, what can cause them, how you work them up, etc. I had Mary bring him in, working him in over lunch to give me extra time to discuss the news with him and answer his questions.

He came in, and I took some time. I explained the findings, and what they might mean. I went over the steps to work them up further, including a spinal tap and labs. He and his wife sat in silence as I went over everything. Finally, I opened up the floor for questions.

Mr. Sternberg: "These abnormal findings, could they be caused by lymphoma?"

Dr. Grumpy: "You have lymphoma?"

Mr. Sternberg: "Had. About 10 years ago."

Dr. Grumpy: "How did they treat it?"

Mr. Sternberg: "I had chemotherapy, and they did radiation treatment on my whole body and head."

(Pause. I pick up the phone and call the neuroradiologist, who says that, yes, absolutely, the changes are typical for someone who's had radiation).

Dr. Grumpy: "Yes, they're likely from radiation. Why didn't you tell me you had lymphoma?"

Mr. Sternberg: "I didn't think it was important. By the way, my headaches are gone."

Today's lesson people: When the neurologist asks about your past medical history, lymphoma and brain radiation are things you want to mention.

Monday, July 11, 2016

Seen in a chart

Nothing can make a doctor look stupider than an EHR (computerized charting) system.

Smoking is, to me, a good example. We all ask "Do you smoke?" There are 3 basic answers: "Yes," "No," and "I used to."

That isn't so hard. I mean, yeah, occasionally you'll get someone who uses snuff or has some other answer, but in 98% of cases the answer is one of those three. My somewhat primitive human brain can handle them pretty well.

Of course, when you turn this simple question over to an EHR, you get crap like this:





What the HELL does that bizarre combination of phrases mean? In a few lines the patient has gone from being a smoker, to a chain smoker, to a non-smoker, and back to a smoker. And what's an "aggressive non-smoker" anyway? Someone who whips out a fire extinguisher and sprays people who light up?

They tell us these kinds of programs make medicine easier and safer for all involved. I think they're smoking something.

Sunday, June 26, 2016

Vacation time!

Heading out for a bit. Be excellent to each other!

Friday, June 24, 2016

Seen in a chart

I'm so behind on the new drugs.

Wednesday, June 22, 2016

Technophobe

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

Mrs. Analog: "Yes, I faxed you a copy of my records last week, and Dr. Grumpy decided not to take my case. So I'd like them back."

Mary: "He deleted them already, I'm sorry. If we're not going to be seeing you, we don't keep a copy."

Mrs. Analog: "WHAT? You should have just mailed them back!"

Mary: "Ma'am, you sent them to our digital fax number, so all documents faxed go directly to the e-mail. There were never any paper records here."

Mrs. Analog: "But you still could have mailed them back. I mean, how much effort would it have been to pull them out of the e-mail, put them in an envelope, and mailed them back to me? I'd have paid you for the postage."

Mary: "You... can't do that. It's a digital file."

Mrs. Analog: "Nonsense. And they were my only copy!"

Mary: "But... you said you faxed them. Isn't there a copy of them on your fax machine?"

Mrs. Analog: "Is there supposed to be? When I fax stuff the feeder just spits out paper on the bottom."

Mary: "Those are the things you just faxed."

Mrs. Analog: "Does that mean the paper is digital now? Can't you fax the email to me at least?"

Monday, June 20, 2016

Thud

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

Ms. Panic: "I need refills on all my meds! I just realized I'm out!"

Annie: "Okay... hang on... Looks like we have you on 3 of them. You need all 3?"

Ms. Panic: "YES! I'm all out!"

Annie: "Our schedule shows you have an appointment tomorrow?"

Ms. Panic: "I know! I'll be there! But please call these in now, I'M ALL OUT!!!"

Annie: "Okay, will do."


The next day...


Dr. Grumpy: "How you doing?"

Ms. Panic: "A lot better since I was last here! Thank you."

Dr. Grumpy: "Annie called in your refills yesterday. I guess you were out?"

Ms. Panic: "Yeah, I ran out a week or two ago."

Dr. Grumpy: "A week or two ago? Did you get them yesterday?"

Ms. Panic: "No, I decided not to. I don't think I really need them anymore."

Friday, June 17, 2016

Beam me up

Dr. Grumpy: "Is that Cochran with or without an E on the end?"

Mr. Trek: "No E."

Dr. Grumpy: "Okay."

Mr. Trek: "Zefram Cochrane has an E at the end."

Dr. Grumpy: "Who's that?"

Mr. Trek: "Sheesh. He invented the warp drive in 2063."

Wednesday, June 15, 2016

Uh..., yes?

Last night I was doing an online survey about the treatment of epilepsy, and this question came up:



Monday, June 13, 2016

Memories...

Years ago my father-in-law hit me up for Viagra samples. I was happy to give him some, but Viagra reps generally don't call on neurologists.

But, because I like the guy, and Christmas was around the corner, I asked my drug rep about it. She was able to have some shipped to me (probably thought they were for me). So I packed them up and mailed them to his house.

About 2 weeks went by, and I didn't hear from him. I began wondering if they were lost in the mail, so I called him. Turned out, due to heavy snow fall and being retired, they hadn't been down to their mailbox for 1-2 weeks. He thanked me for having sent them, and put his wife on the line to chat.

While she and I were talking I heard some crashing noises in the background, followed by a loud mechanical roar.

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

Mother-in-law: "No idea what he's doing. He tore up the garage looking for something, and then just ran out in the driveway with the snowblower. I wonder what he's up to?"

I told her I had to take a call from the hospital, and got off the phone.


Note: This post is just for the humor. For those who want to write in about the medical-legal aspects of this... It happened early in my career, when I was young and naive. Time and experience have taught me not to do things like this.

Friday, June 10, 2016

Fandom

Lady comes in.

Mary: "Hi, can I help you?"

Lady: "I have an appointment with Dr. Grumpy at 10:45."

Mary: "Oh, okay, you're a bit early. Have a seat and he'll take you back when he's done with the current one."

Lady: "Okay."

She walked over to the center table and combed through the 20 or so magazines on it, scanning the covers, then setting them down. Then she did the same with the handful of magazines and patient pamphlets piled on the 2 corner tables. Failing to find anything of interest, she walked over to the wall rack and carefully picked through the dozen or so magazines there before finding one she liked.

Then she sat down and, until called back for her appointment 20 minutes later, used it only to fan herself.

Wednesday, June 8, 2016

Conundrum

I never know what to do with these.

MRI's and MRA's and all our toys are good. They can see stuff we never could, even 5-10 years ago. So, as they get better, they find more.

But that's not always good

I have a lady in her mid-70's. A few years ago her internist did a brain scan on her and found a small aneurysm.  It wasn't related to her symptoms, but since he didn't know what to do with it, he sent her to me.

I reassured her that it wasn't anything. But, since some small aneurysms will grow into large ones, I'm stuck following it. Otherwise, if she drops dead of a ruptured aneurysm at some point, her family can sue me because I didn't look to see if it was getting bigger. CYA. This is defensive medicine at its finest, and, once you've been sued, you'll practice it, too.

Of course, she could refuse the test, but most people don't. As long as it's covered by their insurance, why the hell not?

So every few years I order a repeat study, though at this point it's starting to get silly. I mean, even if it were growing, surgery at this point would pose a bigger danger to her than the aneurysm. But she wants the test, her daughters want the test, and my personal feelings take a back seat to covering myself.

The repeat study this year was, of course, unchanged. Fine. I sent her a letter saying we'd repeat it in 3 years.

I got a call a few days later... from the hospital, asking me to come see her.

Leaving the MRI place she'd fallen while getting in her car, breaking her hip. Which needed surgery. So now she's in the hospital, post-op, and completely whacked out from unfamiliar surroundings and pain meds. So they needed a neurologist to come see her.

Am I medically or legally, at fault for this? Not really. But I still feel guilty about it. I mean, she could also have fallen at the grocery store or walking to her bathroom, with the same outcome. But, instead, she fell while having a test that I wasn't even sure was needed, but was somewhat obligated to order. Yes, she and her daughters insisted on having the scan, so it's their decision, too.

But I still feel bad. Because of guidelines and defensive medicine a nice older lady had a scan she didn't necessarily need, and in an odd way suffered a complication of it.

Will this change how I practice? Probably not. The culture of defensive medicine is so ingrained into American physicians that it's hard to do otherwise. But stories like this make me wonder what the real cost of it can be.

Monday, June 6, 2016

Seen in a chart


Thursday, June 2, 2016

Relationships

This was scribbled on a patient info sheet, apparently from someone confused over their family who's who.



Which, of course, brings to mind this song...

Wednesday, June 1, 2016

Germ theory


This past Saturday, Craig had a meeting at Ye Olde Burger Dive with some dads and other Boy Scouts to plan out their annual trip to Camp Wannahockaloogie.

I dropped him off and drove away. After I'd run errands for an hour or so, he texted he was done, and I went to get him. He came out, carrying a styrofoam take-home box, climbed in the Grumpymobile, and we headed home.

We chatted about the meeting, and camp, and the food at Ye Olde Burger Dive. When we got to that topic he asked "Hey, Dad, you want some fries?"

"Sure," I replied.

Craig opened up the styrofoam box and leaned over. It was full of fries and maybe a third of a cheeseburger. So I grabbed some fries and ate them.

Dr. Grumpy: "They have good fries."

Craig: "Yeah, I like them."

Dr. Grumpy: "You didn't finish your burger?"

Craig: "Are you kidding? I love their food. I put my whole lunch away."

Dr. Grumpy: "Huh? Then what's in there?"

Craig: "Oh, some kid named Jake got that but couldn't finish it, and then he had to leave halfway through the meeting 'cuz he wasn't feeling well. So I asked for a box to take his stuff home for Mello."




Monday, May 30, 2016

Memorial Day

Memorial Day, 2016 has the unusual occurrence of falling close to the 100th anniversary of one of the most terrible naval battles of all time. Therefore, to mark both, I'm going to devote this year's column to a service member from another country.

The WWI Battle of Jutland was the first, and only, large scale battle between the massive dreadnought battleships that had come to exist in 1906. There were other clashes of them, but none on this scale.

HMS Dreadnought, when built in 1906, immediately made all previous battleships obsolete. Her existence set off a massive naval arms race that involved the British Commonwealth, America, Germany, Austria-Hungary, Spain, France, Japan, the Ottoman Empire, Russia, Italy, Brazil, Argentina, and Chile.

On the night of May 30th-31st, 1916, both the German and British battle fleets left harbor, each thinking they were luring the other into a trap. All together there were 250 ships, carrying 105,000 men, on a collision course. Surprisingly, both fleets almost missed each other, and the battle was started by a small Danish freighter innocently blundering between them. Both sides sent small ships to investigate her, which sighted each other.

The battle raged on & off into night and early morning. When it was over 25 ships of various types had been sunk and 8,645 men killed. Although these losses were small compared to the terrible land war being fought in France, they were shocking for naval combat. And the battle, surprisingly, changed very little. Germany won a tactical victory, but the overall strategic victory went to Britain. The course of WWI hadn't changed.

And that's my summary. For those who want to learn more, I recommend watching this. Otherwise, just skip to the next paragraph.







The flagship of the British battlecruiser fleet was HMS Lion, led by Vice Admiral David Beatty. It was his division that had the first main contact with the Germans.

On board Lion was Major Francis Harvey of the Royal Marines. Born in Kent to a family with a long military tradition, he joined the navy at age 14. There he was quickly recognized for his proficiency in languages, gunnery, and debate.

He worked his way up through a series of ships, eventually becoming a gunnery instructor and in charge of training the crews of the navy's Channel Fleet. When World War I started, he was assigned to Lion, commanding one of her main gun turrets.

At Jutland, midway through the battle, Lion was hit several times by Admiral Hipper's flagship Lutzow. One shell penetrated the armor of Harvey's turret and exploded inside. The result blew the roof & front off the turret, killed or seriously wounded every man inside, and set fire to the bags of cordite explosive that were being readied for the next round.

Harvey was still alive. He'd had both his legs blown off, and was losing blood rapidly. Death was coming quickly. But he saw that the hatch separating the turret from the ammunition magazine below was jammed open by a piece of metal. When the burning cordite exploded the fire would spread down into the magazine and destroy the entire ship.

He dragged himself to the speaking tube and ordered the magazines below him flooded with sea water. When the fire did indeed spread a moment later, the ship was saved by his action.

The order was issued with Harvey's last breath. Immediately after giving it he collapsed dead.

Winston Churchill later wrote "In the long, rough, glorious history of the Royal Marines there is no name and no deed which in its character and consequences ranks above this."

Harvey was posthumously awarded his country's highest decoration, the Victoria Cross. His wife and son received the medal from King George V at Buckingham Palace. In 1973 his son loaned it to the Royal Marines Museum, where it can be seen today.

Harvey himself was buried at sea the day after the battle. His name is inscribed at the Chatham Naval Memorial. He was 43.



Thursday, May 26, 2016

Memories

 


The person who ran the residencies where I trained was a neurosurgeon, who had a ginormous house. Like 15,000 square feet. 3 stories. With more rooms than anyone could possibly want.

And a really, really, really old cat.

One of the other neurology residents (Dr. Brownnose) volunteered to house-sit for him, which involved taking care of the cat. It was diabetic, and needed frequent insulin shots.

One night, she lost track of the cat. Since the doors had been closed all day, she knew it was somewhere in the house.

I was woken up at 11:45 that night as she frantically called the rest of the neurology residents to come over and help her find the missing pet (taking care of cats was beneath the dignity of the neurosurgery residents, who wanted nothing to do with it).

Because, after all, "accidentally killed neuroscience program director's beloved family pet..." just doesn't look good on a resumé.

We drove from the inner city by the hospital out to suburbia. And, in the wee hours of the morning, 5 of us were combing back & forth through this massive house with flashlights and cat treats, trying to find the feline and hoping it was still breathing.

I don't remember anymore who found it, asleep beneath an antique chair. It got carried downstairs for its insulin shot, giving us this hateful "I can't believe you monkeys woke me up" look.

We made her take us out for happy hour the next week. And boy, did we run up a tab.

Tuesday, May 24, 2016

My life of crime

It's late afternoon. I'm at my desk, returning calls.


Mr. Stroke: "Hello?"

Dr. Grumpy: "Hi, Mr. Stroke, it's Dr. Grumpy. You had an appointment with me yesterday."

Mr. Stroke: "Yes. What's up?"

Dr. Grumpy: "I got your hospital records, and it doesn't look like they did an ultrasound of your heart."

Mr. Stroke: "Is that important?"

Dr. Grumpy: "Yeah, because the clot may have come from there. I'd like to have Annie set one up, so she'll call you tomorrow."

Mr. Stroke: "Okay, excuse me, what? HEY!"


Pause


Dr. Grumpy: "Hello?"

Ms. Daughter: "WHO IS THIS? YOU SHOULD BE ASHAMED OF YOURSELF!"

Dr. Grumpy: "This is Dr. Grumpy, I saw your dad yesterday. You were at the appointment."

Ms. Daughter: "You even sound like him, too. I'm going to let him know as soon as he opens in the morning that his charts have been hacked. My father is an elderly veteran, and here scum like you are trying to steal his identity and medical information."

Dr. Grumpy: "No, this really is Dr. Grumpy. All I'm trying to do is set your dad up for a heart study."

Ms. Daughter: "Uh-huh. I know how you people operate. I've got the number you called from on the caller ID, and I'm turning it over to the police."

Dr. Grumpy: "It's my office number."

Ms. Daughter: "Rot in hell, asshole."

Click

Friday, May 20, 2016

MARY!!!!!!!!! HELP!!!!!!!!!!!

Dr. Grumpy: "Any changes in your health since I last saw you?"

Ms. Doda: "No, nothing ... Oh wait, I had surgery last fall."

Dr. Grumpy: "Okay, was it..."

Ms. Doda: "I got boobies! Implants! Check these girls out!"

(Whips off shirt)

Wednesday, May 18, 2016

Seen in a chart

This is how a note I received from a neurosurgeon ended. Thanks, guys, that really helps.



Monday, May 16, 2016

Bon appétit!



Like many offices, we have a small dish on the front counter full of generic hard candies (peppermints, butterscotches, Werther's, Jolly Ranchers, etc.).


Lady waiting for her appointment comes up to front counter.


Lady: "Can I have one of these candies?"

Mary: "Sure. Help yourself."

Lady: "Thanks. I didn't have time to get breakfast today."


She picked up THE WHOLE JAR, carried it back to her chair, and in the space of about 5 minutes unwrapped and crunched through about 20 pieces of hard candy.

Then she brought the empty jar back to Mary, full of wrappers.


Lady: "Thanks."

Wednesday, May 11, 2016

Overheard at the nurse's station

"BITCH! You're the worst nurse ever! Get the fuck out of my room! But first, get me more morphine!"

Monday, May 9, 2016

May, 1927

89 years ago this week...

Charles Lindbergh is a household name. Children learn at a young age that he was first person to fly non-stop between New York and Paris in the Spirit of St. Louis.

But 2 weeks before his famous flight, a brave pair of Frenchmen took off from Paris planning to fly nonstop to New York, and have their names enter the history books instead of their American rival.


Francois Coli and Charles Nungesser

Instead, they vanished.

Francois Coli and Charles Nungesser (ages 45 and 35) were both excellent pilots. Coli was a highly decorated veteran of WWI, who'd been making record-breaking distance flights across the Mediterranean Sea for several years. Nungesser was also a talented flier, and France's 3rd most successful ace in WWI. Like their American contemporary, Charles Lindbergh, they were chasing the $25,000 (in 1924 money) Orteig Prize, which would be awarded for the first nonstop New York-Paris flight across the Atlantic.

They spent 2 years modifying a Levasseur PL.8 biplane, adding extra fuel tanks and reinforcing the structure for the long flight to come. The engine was run in the factory for over 40 consecutive hours to test its reliability. The bottom of the plane was rebuilt so it could land on water, and their plan was to arrive in front of France's gift to America, the statue of Liberty, to complete the record breaking journey. A wheeled carriage would be used for take-off from land, then dropped. The plane was painted white and named L'Oiseau Blanc - "The White Bird."

Their route was an arc over the northern Atlantic, taking them from Paris, across the English Channel, England, and Ireland. On the other side of the Atlantic they'd gradually turn south and fly over Nova Scotia, Maine, Boston, and finally come down in New York harbor. They had enough fuel for 42 hours of continuous flight, and were going at a time of year known for better weather. Coli was one of the best navigators of the era - in an age where flights over water relied entirely on celestial navigation. Like most planes, they had no radio.

The guts to do this sort of thing must have been remarkable. For the most part we take long-distance flying for granted today. But at that time they were using technology as unproven to them as the earliest space flights were to another generation. The planes were wood, metal, and cloth. Engine reliability was iffy at best. Navigation was largely educated guesswork. The White Bird's cockpit was open to the elements, and behind the wings. They had nothing over their heads, so were exposed to wind, rain, and cold.

At 5:27 a.m. an May 8, 1927, they took off from Paris's Le Bourget Field, dropping the wheeled sled that was used for the take-off. Within minutes the electric signal had been received in New York that the White Bird was on its way. Crowds in Paris watched as they disappeared into the distance. They continued over England and Ireland on their way into the history books. The last man to see them was a priest in Carrigaholt, Ireland.

On May 10, large crowds gathered in New York to watch the historic arrival. No one had ever flown from Paris non-stop, and it was a big day in the development of the amazing airplane.

But it was not to be. The White Bird never appeared. After several hours of waiting, the crowds dispersed, not knowing what had happened to the 2 brave Frenchman.

And 89 years later, we still don't know.

For 2 weeks, the armed forces of France, England, Canada, and America scoured as much of the Atlantic and northeastern North America as possible. But no trace of them was ever found. Writing of their attempt afterwards, Lindbergh noted they'd "vanished like midnight ghosts."

For several years it was assumed they were victims of a storm, or navigational error, or mechanical problem. The North Atlantic is cold, gray, foggy, and unforgiving. If they were forced to come down far from land, they'd have no real chance of survival. A navigation error could put them far off course, heading for desolate areas as their fuel ran out.

But the odds are that they didn't fail entirely.

As years went by, disparate stories drifted in. Fishermen in remote Newfoundland communities seeing a white plane pass overhead on May 9 (in that era an airplane sighting was a rarity). Reports from small towns through Nova Scotia and into Maine, where residents noted either a white plane going by, northeast to southwest, or the sound of an airplane engine above the clouds. One local newspaper even reported a "mystery plane" passed overhead on that day. These were from areas likely unaware of the White Bird's attempt.

The stories, initially disconnected, meant little. But as researchers dug there were 2 common threads: they all took place on May 9-10, 1927, and all were in a line that sequentially followed the final leg of White Bird's planned course to New York City. In that era there were no other planes that would account for them.

And the reports stopped somewhere in Maine.

Anson Berry (died 1936), a hermit outside of Machias, Maine, knew nothing of the White Bird and didn't read newspapers. But on trips to buy supplies, he told many townspeople about a day in May, 1927, when he'd heard a low-flying plane engine sputtering somewhere above the clouds... Followed by a loud crash in the distance.

Rumors have cropped up over time. A plane wreck seen in a lake. A ruined engine, possibly from a plane, found in the forest and sold for scrap. A few odd pieces of metal and wood have been collected in the area, but nothing that can clearly proven to have been from the plane.

Two weeks after the White Bird vanished, Charles Lindbergh made the first successful non-stop New York - Paris air crossing in the Spirit of St. Louis. Although evidence suggests the Frenchmen beat him by 2 weeks, their exact landing place and fate remain a mystery. Perhaps someday it will be solved.

On the cliffs of Étretat, in France, is a monument to mark the last place Nungesser and Coli flew over their homeland as they headed west.

Near their take-off spot at Le Bourget field is a monument to both they and Lindbergh, inscribed "A ceux qui tentèrent et celui qui accomplit" ("To those who tried and to the one who succeeded").

At the nearby French Air & Space Museum, is the only proven relic of their brave journey: the wheeled sled that the White Bird used for take-off, and then jettisoned.


Sunday, April 24, 2016

Time out

All fine here, but due to some unanticipated family craziness I have to take a week or two off from the blog to catch up on other stuff. Sorry, but I promise that I'll be back.



Friday, April 22, 2016

Harmony

Him: "Am I your token black patient?"

Me: "No. Am I your token Jewish doctor?"

Pause

Him: "Dude, I like you."

Wednesday, April 20, 2016

Just another manic Monday

Mrs. Fennec called, asking for an urgent appointment. Mary had an afternoon slot open, and put her in.

She came in with her dog. This isn't uncommon in my practice, so I didn't think much of it.


Dr. Grumpy: "So what's going on? Mary said you had an emergency?"

Mrs. Fennec: "Yes! Fluffy ate my bottle of Strokoxx!"

Dr. Grumpy: "Uh, are you okay?"

Mrs. Fennec: "I'm fine! But what should we do about Fluffy?!!!"


(I look at Fluffy. He looks at me and cocks an ear to the side.)


Dr. Grumpy: "Well, you should take him to your vet to get this checked out."

Mrs. Fennec: "BUT YOU'RE THE ONE PRESCRIBING THE STROKOXX!!!"

Dr. Grumpy: "Yes, but I have no idea what it does to dogs. Or how to handle it. Or much about dogs at all. Who's your vet? Why don't I call and tell them what's going on, and you can head over there..."

Mrs. Fennec: "It's YOUR medication. You prescribed it! So you should be handling any issues it causes."

Dr. Grumpy: "Well, yes, as far as people go. But not dogs."

Mrs. Fennec: "You're refusing to treat Fluffy because he doesn't have insurance!"

Dr. Grumpy: "This has nothing to do with money. I'm not a veterinarian. You need to take him to someone who knows what to do for him."

Mrs. Fennec: "This is ALL YOUR FAULT, and I'm going to send you the vet's bill!"

(She got up and stomped out. Fluffy, I swear, looked back and winked at me.)


Tuesday, April 19, 2016

Specificity

Dr. Grumpy: "Have you ever had physical therapy?"

Mr. Vague: "Yeah."

Dr. Grumpy: "Where?"

Mr. Vague: "I don't know. It was a therapy place."

Dr. Grumpy: "Do you remember where it was?"

Mr. Vague: "Somewhere around Grumpyville, I think."

Monday, April 18, 2016

Seen in a chart


Friday, April 15, 2016

Friday re-runs

While at Local Grocery after work I was sighted and approached by a patient.

An Alzheimer's patient.

Bill.


Bill: "Uh, excuse me? Hello."

Dr. Grumpy (looking up): "Yes, I, oh, uh, hi"

Bill: "I know you, um" (he leaned forward, and I realized I had my hospital ID clipped to my shirt) "You look familiar, um Ibee Grumpy?"

Dr. Grumpy: "Yes, Bill, how are you?"

Bill: "Don't tell me, it'll come! I know! You work here!"

Dr. Grumpy: "No, Bill, I'm..."

Bill: "Can you tell me where breakfast cereals are? My wife asked me to get some Corn Flakes."

Dr. Grumpy: "Uh, aisle 16, that way, about halfway down."

Bill: "Thank you."

As he walked away I realized he had a box of Corn Flakes in each hand.

Wednesday, April 13, 2016

Mary's desk

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

Ms. Stannum: "I need to see the doctor, but want to ask some questions first."

Mary: "Okay, what can I help you with?"

Ms. Stannum: "I'm having terrible problems on my left side, and I need to know what's going on. But I can't have any tests, so is he the kind of doctor who will order them?"

Mary: "Well, that's something he would have to decide during the appointment, but I can tell you that he does order MRI's and labs, and...."

Ms. Stannum: "DIDN'T YOU JUST HEAR ME? I said I can't have any tests! I'm deathly allergic to the metal used in needles to draw blood and those electrodes they put on your skin!

Mary: "All right, but..."

Ms. Stannum: "And the magnetic rays and X-rays that scanners give off devastate me. I mean, I've had them in the past from all my other neurologists, but then I'm bed-bound for weeks afterwards. WEEKS. Last time I had to take short term disability until I could recover from the effects they have on my brain waves."

Mary: "Maybe you..."

Ms. Stannum: "And I can't take any pills. The chemicals they use in them are all poisons to me. I've nearly died from them thousands of times. LITERALLY. THOUSANDS! So I need a doctor who can help me get better, but who won't make me have any tests or take any pills."

(pause)

Mary: "I don't think Dr. Grumpy and you would be a good match. You might want to try another office."

Ms. Stannum: "That's the problem with modern medicine. Nobody cares about helping sick people."

(click)

Tuesday, April 12, 2016

Texting with Frank

I wandered out to put stuff in my car, to discover a large penis drawn on the dirty back window.

Obviously, I need to wash my car more often.

This sort of thing generally indicates Frank is the perpetrator, so I texted him.




Monday, April 11, 2016

April 11, 1755

Today is International Parkinson's Disease day.

Parkinson's Disease is something I deal with a fair amount. As most know, it's a progressive neurological disease typically characterized by tremor, imbalance, and slowness of movement.

And that's all I'm going to say about it here.

So why did I bring it up? Because the man behind the disease is fascinating. Mostly remembered now only by the neurological disorder he described, there was a lot more to him. Probably one of the more remarkable figures of his (or any) time.

James Parkinson was born on this day in 1755. His father, John, was a London pharmacist and physician. While a medical student, in 1777, James and his father received medals for successfully resuscitating a man who'd hung himself.

During medical school he wrote a pamphlet about his experiences called "The Medical Pupil." Perhaps this could be seen as an early example today's med student blogs. In words that still ring true 240 years later, he opined that "a sympathetic concern, and a tender interest for the sufferings of others, ought to characterize all those who engage themselves in the profession, the object of which should be to mitigate, or remove, one great portion of the calamities to which humanity is subject.”

Preach it, brother James.

In 1784, upon John's death, James took over the practice. It was a successful one, treating rich and poor alike. He also served as the supervising physician at a large local mental institution. He married Mary Dale, and they had a total of 8 children, 6 of whom survived to adulthood.

Parkinson was politically active and, for the time, radical. He strongly supported equal rights for the poor (OMG!), voting rights for women (gasp!), and the inclusion of "ordinary citizens" as a major portion of government. He campaigned extensively for decent treatment and legal protection of the mentally ill, realizing that those with serious illnesses were often incapable of recognizing their actions.

He wanted annual elections to make sure parliament turned over with "new minds" frequently, and supported the French Revolution across the channel. He wrote and published numerous political pamphlets, but to protect his family and practice wrote under the pen name "Old Hubert." When a political group he was involved in was falsely accused of plotting to assassinate King George III (the Pop-Gun Plot), Parkinson refused to testify against his friends. Eventually all charges were dropped when it was revealed they were trumped-up by political opponents.

During his medical career he published a treatise on gout and went on to write the first English language description of acute appendicitis. He and his son (also James, and also a doctor) were the first to prove that death from appendicitis was due to visceral perforation and infection.

As a member of the Association of Apothecaries (later its president) he saw a key act passed in 1815 that, for the first time, regulated the standards to which doctors and pharmacists had to be trained. He was also instrumental in passing laws concerning apprenticeships, setting goals for training and protecting the apprentice from abuse.

He wrote medical & science columns for popular newspapers on such varied subjects as chemistry, nosebleeds, and hypochondria, and also published scientific papers on topics as disparate as lightning, fossils, and geology.

In the 1810's, based on observations of both his own patients and  individuals he'd seen walking around London, he first recognized the characteristic tremor and shuffling gait of the disease that today has his name. He also differentiated between the types of tremors commonly seen - a key diagnostic point still used by neurologists today.

In 1817 he published his landmark piece "An Essay on the Shaking Palsy" in which he described the main features of the disorder. The accuracy of the paper in describing the condition is made all the more remarkable by the fact that neurology as a field didn't exist at the time. Jean-Martin Charcot, the Frenchman who would go on to found my medical specialty, was born 8 years later in 1825. It wasn't until 1877, 60 years after Parkinson's essay, that Charcot himself named the condition Parkinson's Disease. His English colleague, William Gowers, agreed with Charcot's eponym.

Sadly, this discovery obscured many of his equally remarkable accomplishments.

Besides those interests mentioned above, Parkinson's scientific curiosity led him in many directions. He examined rock specimens at length and wrote a breakthrough treatise on the sediment patterns and fossils seen through the British Isles, recognizing the organization and significance of different rock strata.

He authored 2 books on fossils from around the world, describing them as earlier stages of currently living animals (Darwin's theory of evolution wouldn't be published for another 40 years). He also did his own black & white illustrations for the books, while his daughter did the color plates.

A species of Ammonite, a long-extinct relative of the modern octopus and squid, was named after him. So was an ancient branch of the turtle family. He has the unusual distinction among scientists of having both a disease and fossils attached to his name.

In 1823 the Royal College of Surgeons presented him with an award for his extensive body of work, noting “The fruits of your exertions are distinguished by the stamp of simplicity and truth. They express the most laudable zeal in the pursuit and the promulgation of knowledge, for the benefit of mankind.”

James Parkinson died on December 21, 1824 of a stroke, very close to where he was born and spent his entire life and practice. He was buried at St. Leonard's church, though no stone was placed and the exact location of his body is unknown.



Friday, April 8, 2016

Seen in a chart


Thursday, April 7, 2016

Making the call schedule

Dr. Brain can be a bit of a snob. Sometimes I play stupid just to irritate him.


Dr. Grumpy: "Okay, I'll take call the first weekend of the month, Dr. Cortex the second, and..."

Dr. Brain: "You'll have to put someone else on for the last weekend. My wife and I have tickets for Andrea Bocelli."

Dr. Grumpy: "Okay, I'll put Dr. Nerve on there, so if you'll take the third weekend it should all work out."

Dr. Brain: "These are FRONT ROW tickets. I paid a fortune for them."

Dr. Grumpy: "Okay, now for the following month..."

Dr. Brain: "Do you know how hard it was to get these tickets?"

Dr. Grumpy: "Um, no. Who's Andrea Bocelli?"

Dr. Brain: "A singer."

Dr. Grumpy: "I've never heard of her. Is she like Lady Gaga?"

Dr. Brain: "No! He's a man, and..."

Dr. Grumpy: "Was he the guy I saw who had a small stroke last summer? I think you said he played guitar at a coffee place?"

(pause)

Dr. Brain: "I'm available any weekend the following month."

Tuesday, April 5, 2016

Great moments on call

Dr. Grumpy: "Can I get a swallow evaluation on Mrs. Stroke, in room 63?"

Speech therapist: "Of course. Do you want African or European?"

Monday, April 4, 2016

April 1st

Since so many of you are forwarding this to me, I figure I might as well share it for those who haven't seen it.


Friday, April 1, 2016

Seen in a chart

I often have that last problem myself:




For the non-medical readers, it's supposed to say "volume depletion."

Thank you, M!
 
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