No shit, Sherlock

These are the kinds of warnings that modern, technologically advanced, highly sophisticated computer prescribing systems give us dumb ol' doctors when we're trying to refill your medication. Because even if we're just refilling it, the computer wants us to know that IT'S DANGEROUS TO DO SO because apparently you're already on it (which is the whole point of a refill, isn't it?).

And what's with the weird capital / lower case scheme on some of these?

Breaking news

Dr. Grumpy's crack team of reporters continue to bring you the stories that shape your world.

The summer amusement park season is upon us, and unfortunately tragedy has already struck at America's most legendary one.

This past Friday night 17 people, including 6 innocent children, were enjoying an up-till-then fun day at Disneyland. They were standing near Sleeping Beauty's castle when they were horrifically splattered with a large volume of bird poop from a passing flock of geese.

An unidentified bystander, who apparently doesn't know shit, called 911 to report that someone was throwing human turds at people.

This resulted in a city HazMat team being dispatched to the scene, hopefully in those bright yellow suits so people would think they were re-enacting a child alert from Monsters, Inc.

The crappy situation was resolved by taking the victims to a "private restroom" (what does that mean, anyway? No one has used it since Walt died, like the room over the fire station?). There they were provided with clean clothes ("Birds shit on me at Disneyland and all I got was this crappy T-shirt").

At press time the geese were unavailable for comment.

Research

Dr. Grumpy is no stranger to not-particularly-worthwhile research, having published some myself.

I get it. You didn't want to do it, but you're in training, and your chairman made you write up something embarrassingly bad in order to graduate. BTDT.

Last week, some of the biggest names in Parkinson's disease (besides James Parkinson) gathered in Vancouver, BC, for a conference.

One of my colleagues there noticed this poster hanging in the meeting's research hall:

To summarize:

Earthquakes are bad. Having Parkinson's disease, AND being in an earthquake, is worse.

The bigger the earthquake, the greater the effect will be on a Parkinson's patient.

Their symptoms will get worse in the immediate aftermath of the quake, but gradually return to baseline as things settle down.

Thank you, SMOD!

Holiday road

All right, with the kids' band stuff, school getting out next week, the kids' band stuff, visiting relatives who have given us short notice, all sorts of school-year-end craziness, and the kids' band stuff, I'm going to have to take 2 weeks off from the blog to deal with the insanity.

And I need to pick up beer.

Lots of beer.

See you in 2 weeks!

Friday reruns

One of my all-time favorite chart excerpts:

Calls

Ms. Auth: "Major Illness Insurance."

Dr. Grumpy: "This is Dr. Grumpy. I'm calling to get a medication authorized on a patient."

Ms. Auth: "Okay, what is their 10 digit ID number"

Dr. Grumpy: "It's... The only number on her card is 7-digits, 8675309."

Ms. Auth: "No, I need the 10 digit one"

Dr. Grumpy: "There isn't another number on here."

Ms. Auth: "Well, I can only work with the 10 digit one."

Dr. Grumpy: "What about her name and birthday? Or Social Security number?"

Ms. Auth: "We don't use those. The only thing I can work with is her 10 digit number."

Dr. Grumpy: "How do I get that?"

Ms. Auth: "Call back and press option 5. Then enter her 10 digit number in order to get it."

Dr. Grumpy: "But I don't have the 10 digit number!"

Ms. Auth: "Then we can't help you, can we? Have a nice day."

Stress

Dr. Grumpy: "That's odd for you to have a seizure. Did you miss a medication dose?"

Ms. Rummage: "Yeah... Actually I haven't taken it for almost a week."

Dr. Grumpy: "Did you run out?"

Ms. Rummage: "No, I've just been really stressed out over having a garage sale."

May 20, 1937

80 years ago tomorrow, one of the finest moments in BBC history occurred.

Lt.-Cmdr. Thomas Woodrooffe was a retired Royal Navy office who covered the navy for BBC news. He’d previously served on the battleship HMS Nelson.

In 1937 the fleet held a large review at Spithead, which included the visiting battleship USS New York. The plan was for him to broadcast that evening from aboard HMS Nelson, when all the ships would have lights strung in their rigging.

Unfortunately, after he boarded Nelson he ran into many of his old shipmates, and they decided to have a drink... then another... then a few more... With the end result being that when Woodrooffe took the microphone that night he was completely smashed drunk.

To the horror of his bosses, his live BBC news broadcast consisted of his slurred, inebriated voice, repeatedly saying the fleet was “all lit up, like fairyland” (obviously, the fleet wasn't the only thing lit up) and rambling into the microphone. In that era the technology to cut him off and switch to something else wasn’t readily available, so he was able to go on for several minutes before they finally pulled the plug.

For those who want to listen, this is the actual recording.

If you want to read it, here's a transcript:


ANNOUNCER'S INTRODUCTION:

This is the Regional Program. The Illumination of the Fleet. Once again, we're taking you on board HMS Nelson for a description of the scene at Spithead tonight by Lieutenant-Commander Thomas Woodrooffe.

LIEUTENANT-COMMANDER WOODROOFFE:

"At the present moment, the whole fleet is lit up. When I say 'lit up', I mean lit up by fairy lamps.

"We've forgotten the whole Royal Review... we've forgotten the Royal Review... the whole thing is lit up by fairy lamps. It's fantastic, it isn't the fleet at all. It's just... it's fairyland, the whole fleet is in fairyland.

"Now, if you'll follow me through... if you don't mind... the next few moments... you'll find the fleet doing odd things. At the present moment, the New York, obviously, is lit up ... and when I say the fleet is lit up ... in lamps... I mean, she's outlined. The whole ship's outlined. In little lamps.

"I'm sorry, I was telling some people to shut up talking.

"Umm... what I mean is this. The whole fleet is lit up. In fairy lamps, and... each ship is outlined.

"Now, as far as I can see is about... I suppose I can see down about five or six miles ... ships are all lit up.

"They're outlined, the whole lot. Even destroyers are outlined. In the old days, you know, destroyers used to be outlined by a little kind of pyramid of lights. And nowadays... destroyers are lit up by... they outline themselves.

"In a second or two, we're going to fire rockets, um, we're going to fire all sorts of things, and... you can't possibly see them, but you'll hear them going off, and you may hear my reaction when I see them go off. Because, uh, I'm going to try and tell you what they look like as they go off. But at the moment there's a whole huge fleet here. The thing we saw this afternoon, this colossal fleet, lit up... by lights... and the whole fleet is in fairyland! It isn't true, it isn't here!

"And as I say it ...

"It's gone! It's gone! There's no fleet! It's, uh, it's disappeared! No magician who ever could have waved his wand could have waved it with more acumen than he has now at the present moment. The fleet's gone. It's disappeared.

"I'm trying to give you, ladies and gentlemen... the fleet's gone. It's disappeared. I was talking to you... in the middle of this damn (cough), in the middle of this fleet... and what's happened is the fleet's gone, disappeared and gone. We had a hundred, two hundred warships around us a second ago, and now they've gone, at a signal by the Morse code, at a signal by the fleet flagship which I'm in now, they've gone, they've disappeared.

"There's nothing between us and heaven. There's nothing at all."

Wednesday reruns

Last night I was at a dinner meeting for a research company. These things are always held at some swanky overpriced steakhouse.

Dr. Duffel is a local neurologist who drags around the biggest damn purse in the world. It's HUGE, and goes everywhere with her. For years many of us have wondered what's in it: a complete set of every neurology journal ever written? Jimmy Hoffa? an iPhone 87s+?

So last night she came in late to the dinner, and sat down next to me. She put el monstro humungo purse on the floor next to me, so I had to move over a bit.

The meeting dragged on. One slide after another. The occasional cell phone ringing. The speaker droning. Food courses.

At some point I wandered out to stretch and empty myself of biologically-filtered Diet Coke. When I came back and sat down I stepped in a puddle on the floor. I figured someone must have spilled water or something while I was out of the room, and refocused my attention on the speaker.

A minute later a waitress came by to refill my Diet Coke, and stumbled over the giant purse.

And the purse started barking.

The waitress screamed and leaped back, dropping the pitcher on the purse, which only got it snarling at her.

Dr. Duffel jumped up, grabbed her cell phone (which hadn't rung), mumbled "I have to answer this outside" and dragged her growling purse out of the room. I'm pretty sure it wasn't her ringtone.

She never came back.

I rinsed off my shoes when I got home.

Sunday night

It's 11:18 p.m. I'm fast asleep, and my phone rings.

Dr. Grumpy: "Hello?"

Dr. Brain: "Hi, Ibee? It's me."

Dr. Grumpy: "What's up?"

Dr. Brain: "I couldn't sleep, so I'm reading the new issue of 'Journal of Obscure Neurological Diseases of Burkina Faso.' Have you looked at this months?"
 
Dr. Grumpy: "Uh, it's 11:30 at night and I was..."

Dr. Brain: "They're COMPLETELY changing the diagnostic criteria for Fleaglehart's Syndrome! I disagree with the entire thing. I mean, now they're considering visual changes to be helpful, but not diagnostic, of the disorder. They're increasing the importance of mental status changes, and now there are more than the 2-3 standard MRI findings we're used to."

Dr. Grumpy: "Uh..."

Dr. Brain: "This is RIDICULOUS! I mean, how many cases of Fleaglehart's Syndrome have you seen that would fit this new criteria?"

Dr. Grumpy: "Look. It's 11:30 at night, you woke me up, and honestly I've never seen a case of it."

Dr. Brain. "Really? Neither have I. Okay. Have a good night."

The visitor

I'm in my office looking through MRI reports.


Mary: "Hey doc, there's a drug rep up front, says he needs to talk to you. Says it's not a sales call."

Dr. Grumpy: "Okay, just send him back."

(drug rep comes in)

Dr. Grumpy: "Hi, Matt. What's up?"

Drug rep Matt: "Sorry to bother you, but I was told to come talk to you about a weird request my company got."

Dr. Grumpy: "About..."

Drug rep Matt: "A patient of yours called my company, and said you'd authorize her to get 4 replacement injector pens and we just had to contact your office. I thought I'd come by myself, since we hadn't heard anything about this from you guys."

Dr. Grumpy: "Did you hear what happened to the pens?"

Drug rep Matt: "That's the weird part. She contacted 3 service reps, told one the pens were stolen, another that they were never delivered, and another that her boyfriend backed over them with his car."

Long pause

Dr. Grumpy: "Actually, she and some friends got drunk and then tried using them to pierce their ears."

Long pause 2 

Drug rep Matt: "Are you shittin' me?"

Dr. Grumpy: "Nope."

Drug rep Matt: "I'm going to assume your story is the correct one?"

Dr. Grumpy: "That's the one she called me with Saturday morning."

Drug rep Matt: "I'm pretty sure we don't have a program to replace pens lost through, um, misadventure."

Dr. Grumpy: "Believe me. I understand. We've been dealing with her all week."

Long pause 3.

Drug rep Matt: "Thanks. I'll let you go. Wow. This sounds like something you'd read on a med-blog."

Annie's desk

Ms. Myelin: "Hello?"

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

Ms. Myelin: "Oh, good. Did you order my new MS pens?"

Annie: "No, I just got off the phone with your insurance, and they won't replace pens that are damaged that way."

Ms. Myelin: "That's what they told me, too!"

Annie: "You called them yourself?"

Ms. Myelin: "Yes, I figured you'd just ignore me. Do you have any idea how long they made me sit on hold?"

Annie: "Um, yeah."

Ms. Myelin: "This is ridiculous. I need this medication, and my insurance company won't give it to me, even though it's been authorized and I've paid all my premiums."

Annie: "Well, you get a limited number of pens a year, and that's what they've given you. You broke 4 of them using them for something they weren't designed for."

Ms. Myelin: "Like it's my fault they put such a cheapshit needle on that it broke."

 Annie: "I..."

Ms. Myelin: "Can't you tell them that they were defective? Or that I broke them defending myself from a burglar or something?"

Annie: "I need to point out here that you called them before me, and told them the real story."

Ms. Myelin: "I didn't think they'd be such uncaring assholes. Whatever happened to 'honesty is the best policy'? I'm pretty sure the insurance phone bitch was laughing at me."

Annie: "Well, at this point the only way you can get them replaced is to pay cash."

Ms. Myelin: "WHAT? Do you have any idea how much this costs? It's $1200 for each of their crappy pens."

Annie: "There's really nothing else I can do"

Ms. Myelin: "Can Dr. Grumpy pay for them? He's the one who prescribed it, after all. I just took his advice."

Annie: "No. Maybe you should ask Ashley and Amy for help?"

Ms. Myelin: "I'd never ask my friends to do that for me."

Saturday

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

Ms. Myelin: "Hi, I see you for Multiple Sclerosis, and I'm on that drug you inject with a special pen?"

Dr. Grumpy: "Yes?"

Ms. Myelin: "I need to get 4 new pens ordered for the month. The ones I have are all broken, so I'm going to run out."

Dr. Grumpy: "A month's worth of injector pens were all broken?"

Ms. Myelin: "No. I mean yes. I mean, they are now."

Dr. Grumpy: "Did they get shipped to you broken?"

Ms. Myelin: "I don't think so."

Dr. Grumpy: "So how are they all broken?"

Ms. Myelin: "Well, for Cinco de Mayo me and my girlfriends were at the Smashed Iguana. They were having tequila shot specials, and they do that thing where they pour margaritas right in your mouth? Anyway, we came back to my place to crash, and while we were sitting around Ashley said she'd been meaning to get her ears pierced in new places. Amy volunteered, cause she once did her own when she was in high school and said she'd been meaning to do the same. But I didn't have anything that would really work, then remembered I had my MS drug injector pens and they have pretty sharp needles, so we..."

Dr. Grumpy: "You used MS injector pens to pierce your ears?"

Ms. Myelin: "Well, yes. I mean, on a Friday night at 11:30 it's not like the place at the mall was open."

Dr. Grumpy: "I'll talk to Annie and get back to you on Monday."

Friday reruns

Dr. Grumpy: "So at what point did you call 911?"

Mr. Young: "When I realized she was having a seizure."

Dr. Grumpy: "How long after the seizure started was that?"

Mr. Young: (looks at Mrs. Young, both blush, look at floor) "Well, I didn't call right away, because we were, um, having sex at the time, and when she started shaking I just thought she..."

Dr. Grumpy: "Got it. So how long did the seizure last?"

Losses

Mary: "Let me give you these forms... Here's a pen... can I get a copy of your insurance card?"

Mrs. Card: "No."

Mary: "Do you have it with you?"

Mrs. Card: "Yes, but I don't know Dr. Grumpy yet. Can I give it to you after the visit, if I think he deserves to get paid?"

Rug

Dr. Grumpy: "At your last visit we started Flingase, how's that been going?"

Mrs. Scalp: "It's helped my migraines, but causing a lot of hair loss! I feel like I'm going bald!"

Dr. Grumpy: "Yeah, like we'd talked about, that can be a side effect."

Mrs. Scalp: "The trade-off just isn't worth it. I want to try something else."

Dr. Grumpy: "That's fine. Let me..."

Mrs. Scalp: "Here's this."

(puts a Ziploc bag on my desk)

Dr. Grumpy: "Uh... what's that?"

Mrs. Scalp: "It's all the hair that's fallen out. I've been saving it for today."

Dr. Grumpy: "I, um, see."

Mrs. Scalp: "Since you were familiar with the drug I figured you'd know a way to put it back on. Isn't there a Flingase antidote?"

Dr. Grumpy: "No, but it'll grow back with stopping the drug."

Mrs. Scalp: "Will it all be back by this weekend? I have a wedding to go to."

Dr. Grumpy: "No..."

Mrs. Scalp: "Well, this is a lot of hair." (picks up bag) "Do you have glue or something?"

Honesty

Seen in a chart:

Parking

My office parking is okay. Not great, not horrible. Generally anyone can find a space, but they may have to park farther than they like (we do have plenty of handicapped spots).

I have one patient, Mr. Thuesen-Hale, who perennially complains about it. It's almost Seinfeldian, were it not for him being so enraged. Mary even gave him a list of neurologists who might have a better office lot than I do, to no avail.

So at his appointment last week, he showed up with a bunch of papers. They looked like forms for work.


Dr. Grumpy: "Any other questions?"

Mr. Thuesen-Hale: "Yes, I have this for you."

Dr. Grumpy: "Is it for your job?"

Mr. Thuesen-Hale: "No, it's a parking ticket."

Dr. Grumpy: "A parking ticket?"

Mr. Thuesen-Hale: "Yes. Because of your crappy parking here I got a ticket last time for being on the street. So it's your responsibility to pay it." (shoves papers at me)

Dr. Grumpy: (not reaching for them) "I'm sorry you got a ticket, but I'm not going to pay it."

Mr. Thuesen-Hale: "That's unacceptable. You chose to rent in this building, so it's your problem. PAY IT!"

Dr. Grumpy: "I'm not going to do that."

Mr. Thuesen-Hale: "Look, if you don't pay it I'm not coming back!"


It's funny how some people think that's a threat.

Random pictures

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

First we have this doctor's office:

"How's the weather down there?"

From the "but don't do it right now" department of driving safety:

"Gee, this sounds like a great place to live"

"I guess the gardens are by the rear entrance."

From the music store (for those of you who remember what one was).

"Better not look in the other bin" department:

People who can't spell are watching you:

And, lastly, a reminder of those good old days of pharmacy:

Modern medicine

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

Ms. Thirst: "Yes, I need to make an appointment with Dr. Grumpy."

Mary: "Okay, our next available is on Thursday, at..."

Ms. Thirst: "Wait, first of all, do you offer a beverage service in your lobby?"

Mary: "Uh, no. There's a water fountain down the hall, by the... Hello? Hello?"

Wednesday reruns

Mrs. Powder: "Sorry I'm a few minutes late, I had to drop my husband off at the ER."

Dr. Grumpy: "Is he okay?"

Mrs. Powder: "Oh he's fine. He was cleaning his gun and shot himself, again."

Dr. Grumpy: "Oh my..."

Mrs. Powder: "You'd think he'd get over being such a baby about it. I made him wait in the car until I'd finished the laundry. Anyway, at the last visit you had me try Nomig for headaches, and I like it. Do you have any more samples?"

Mystery

Last week I got a letter from an insurance company about a patient's medication. No biggie. Happens a lot.

The letter said my patient's prescription authorization was expiring next month, and that I needed to fill out and resubmit the forms to get it covered for another year. Okay, I do that a lot, too.

But this letter, in the interest of protecting patient privacy, didn't give me their name. Or the medication. Or their diagnosis. Not even an ID number or birthday. Zilch. Zip. Nada.

In fact, across the top of the letter it said:

And I must admit they were right. The only name on the letter was my own.

So what am I supposed to do? I want to help the patient, but a quick look at my computer says I currently have 1,043 active patients. At least 278 of them are on a medication that requires me to re-authorize once a year. I can't start calling all of them, either. Ones who are coming due in the next 2 months? 44 per my machine. That's still too many for a random guess.

No easy answer here.

Sadly, the way these things usually play out is I'll only know who it is because they go for a refill and are told the medication is no longer covered because uncaring Dr. Grumpy never bothered to do the authorization. So they call and yell at me because they're not going to get their medication "AND IT'S ALL YOUR FAULT!" (my kids love that line, too).

I'm a big believer in patient privacy. I work hard to protect it. But when information about a patient, and a potentially life-saving medication for them, is kept secret from the very doctor who's prescribing it... We've reached a new level of insanity.

Franz Kafka (not my patient)

Supercalifragilisticexpialidocious!

Seen in a chart:

Of course, there's only one medicine that treats it all.

Memories...

One night, just after starting my internship, I got called to pronounce a patient dead.

How hard can that be?

They paged me just after midnight. As I took the elevator to that floor I realized that... I had no idea how to pronounce someone dead.
 
OH, SHIT!

My medical school had covered all kinds of stuff about diagnosis and treatment of the living, and, in retrospect, zilch about how to tell if someone is dead.

My stomach sank as I realized I'd be learning on the fly. I buttoned my brand-new white coat and made sure I had my stethoscope.

I got to the room. Mercifully, the family had gone home for the night and there were just 2 nurses straightening things up.

The ex-patient's eyes were wide open. He stared straight ahead, pining for the fjords.

Trying to look like I knew what I was doing, I strode confidently over to the bed... then stopped as I realized I had no idea where to start.

Finally, I waved my hand in front of his eyes.

He didn't blink.

The nurses began laughing. I began sweating.

Realizing I was hopelessly lost, and blanking, one took pity on me and suggested checking his pulse and perhaps use my stethoscope. At that point I began remembering things like vital signs (or the absence thereof) and other basic proof/disproof of life.

 

"He's dead, um, what's your name?"

I lay in my call room the rest of the night, waiting for a page from the morgue that the guy had woken up and was wondering what kind of idiot had pronounced him dead.

Sunday morning, 12:37 a.m.

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

Mr. Phone: "Yeah, I see Dr. Nerve for my headaches, and when I had one last month he called in some Migroblast, and it was really effective. Do you know if he'll call it in next time I have a headache?"

Dr. Grumpy: "Are you having a headache, sir?"

Mr. Phone: "No, I'm fine, I haven't had one since then. I only get a few each year. But if I have one, will he call in the Migroblast again?"

Dr. Grumpy: "Why don't you call his office on Monday and ask?"

Mr. Phone: "Oh, I guess I can do that. Hey, have a good night!"

Genetics

Mrs. Worry: "I'm concerned about Alzheimer's Disease, because I have a family history of it."

Dr. Grumpy: "Who had it?"

Mrs. Worry: "My ex-husband."

Mary's desk

Mr. Stand: "Hello?"

Mary: "Hi, this is Mary at..."

Mr. Stand: "Um, are you the girl I met last Saturday at Pick-Up Charlie's? Hey, the reason I haven't called yet is because..."

Mary: "Uh, no, I work at Dr. Grumpy's."

Mr. Stand: "I don't remember a bar called Dr. Grumpy's. Where is it? I must have been blitzed. Anyway, I'm glad you called because..."

Mary: "Dr. Grumpy is a neurologist. You have an appointment here at 10:00 tomorrow morning. I'm calling to remind you of that."

Mr. Stand: "Wait, you work at my neurologist's AND you came home with me from Pick-Up Charlie's last weekend?"

Mary: "No. I work here. I'm married. I've never been to Pick-Up Charlie's."

Mr. Stand: "Oh... This is awkward... I guess I'll see you tomorrow at 10:00, then."

100 years to the day

This picture was taken 100 years ago today, off New York City. It's the U.S.S. Arizona, shortly after completing engine repairs and only 6 months after she was commissioned into the navy. 3 days after this picture was taken the United States entered World War I.

At the time she was the biggest, newest, and most advanced battleship in the world. And home to 2,290 young men.

This is the same ship today, after the beginning of another war. 1,177 young men are still aboard her.

Check, please

This weekend Craig is hosting a murder-mystery party for his friends, with crimes he's writing himself.

Last night we stopped for a bite on the way home from band practice. He had a notebook, and was frantically writing down ideas for the party mysteries.

At one point he said "One more to go. I JUST NEED INSPIRATION FOR ONE MORE MURDER!!!"

Saying that loudly gets you some interesting looks in a crowded diner.

Publishing

Dear Cureus,

Thank you for your recent email.

I must say, I'm delighted that you enjoyed my article "," which was published in , . I spent years working on it, as a much-anticipated follow-up study to "?" and ".", which you may have seen in / and ;, respectively.

I'm impressed that your "new and unique" article rating system felt "," was so important. I'd been concerned, as several colleagues were less flattering, comparing it to something one might see produced by a :

Please keep an eye out for my "!" which will be featured in next month's issue of " as the centerfold.

Yours truly,

Ibee Grumpy, M.D.






- Thank you, SMOD!