Seen in a chart

This was in the discharge instructions one of my patients was given in the emergency room:

Thud

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

Mr. Antz: "Hi, I just got a letter from the state saying I need a form to keep my driving privileges? My last seizure was 4 years ago!"

Annie: "Yeah, sometimes they do that randomly. Just come in for an appointment within the next 30 days and we'll get it taken care of. Let me transfer you to Mary to work you in..."

Mr. Antz: "Um, actually I've moved out of state since I was last there. Can you suggest any neurologists here in Bayonne?"

Annie: "No. Have you asked your family doctor for a referral?"

Mr. Antz: "I don't have one. Do you know one here? Or can you call any and get me in ASAP, and for them to waive my co-pay? It's higher if I'm out of state."

Annie: "We can't do that, even if I did know someone."

Mr. Antz: "Okay. I'll be back in Grumpyville next week, anyway."

Random pictures

Okay, time to hit the mailbag for pics you guys have sent in:


First we have this brand of tea:

"Hey, it's cheaper than Viagra."

One stop shopping:

"Earrings, some nice pumps, get the tumor checked out..."

More one stop shopping:

Apparently death is now one of many "things to do"

And, while we're on the subject of death, here's a great headline:

One reader sent in this badly translated set of directions from a desk clock:

And, finally, there's the name of this yoga place. It make me think the instructor is in a leather dominatrix outfit, carrying a whip.

Memories...

Back in medical school, me and my roommate (Enzyme) had a classmate named Cheetah.

Cheetah lived in our apartment building, and had this phobia of being locked out of her car. Hey, we all have our issues, I get that.

Anyway, Cheetah decided she could trust us (bad mistake), so gave us an extra key to her car. That way, if she did get locked out, she could come get it from us.

So, over the next 4 years, every now and then we'd go out and move her car at night. We didn't actually take it anywhere. Just moved it a few spaces over... or into the opposite row... not very far away, but enough to make her come out and say "huh?"

We did this maybe 2-3 times a month. We'd only hear about it in passing, usually her mumbling about how tired (or drunk) she must have been when she'd gotten home the previous night.

This went on for 4 years. She asked for her key back the day after graduation, never once having been locked out of her car.

We didn't dare tell her.

Bad! Bad technology!

Seen in a chart:

Thank you, JP!

Milestones

Due to her hypercompetitive nature, Marie beat both her brothers to be the first with a driver's license.

Since my wife and I need our cars for work, we decided to get one for the kids. We picked-out the closest street-legal thing there is to a tank: an ancient Toyota 4Runner with 290,000 miles on it.

"Marie, are you sure this is the way to school?"

Up until recently Mrs. Grumpy or I have always ridden with her, but now school has started. It was up to Marie to drive herself and the boys to school.

In other words, she was flying solo.

She made both boys sit in the back so they wouldn't distract her.

Of course, Mrs. Grumpy and I were still worried. We decided I'd follow behind them for a few minutes, to make sure everything went fine. Marie (and especially her brothers) were okay with this.

Off we went. Fortunately, Wingnut High School is only 3 miles away. Traffic was light. What could possibly go wrong?

About 2/3 of the way there, one of the boys texted me that the 4Runner was making a funny noise.

At the same time, I noticed smoke had begun pouring out from under its hood.

"Hey, do you mind if I smoke?"

Marie soldiered on. Not stopping, continuing to school. There was no way she couldn't have noticed there was something horribly wrong. Her brothers' texts to me became increasingly frantic that she wouldn't stop the car, wasn't going to pull over, AND HOLY FUCK DAD WE'RE GOING TO DIE!

Eventually, smoking away, she pulled into the school parking lot and found a space. Even with all this going on she carefully pulled in & out of it twice and stuck her head out to make sure she was right between the lines. She didn't seem to notice that everyone in the lot was either running away or taking pictures with their phone.

Except for her brothers, who'd bailed out at a stop sign 2 blocks earlier and were walking.

Then, leaving the engine running, she got out and calmly walked over to my car, signaling me to roll down the window. With remarkable aplomb she said "Dad, what do you do when the car is on fire? They didn't cover that in driving school."

I ran over and turned off the car (fortunately, nothing too horrible turned out to be wrong with it).

A security guard appeared out of nowhere with a fire extinguisher and began randomly spraying stuff.

The boys may need therapy.

Marie, upon being reassured that all would be fine, got her backpack, rolled her eyes at her brothers trudging down the road, and headed off to class.

Winter is coming

And with it, the annual Dr. Grumpy holiday gift guide!

As always, any of you who see something horribly tasteless, useless, bizarre, or otherwise notable, please feel free to send it to me for this year's edition. I can't guarantee I'll use every entry, but will appreciate all of them!

Words

Mrs. Semantics is a nice lady with carpal tunnel syndrome. She's trying to avoid surgery, so is wearing a pair of wrist braces.

Unfortunately, she doesn't call them braces, or splints, or supports.

She calls them cuffs.

Which leads to some entertaining quotes.


"You get odd looks wearing cuffs in public."

"I feel better when I wake up in cuffs."

"My husband put me in the cuffs last night."

Front line combat

Some random lady walks in.

Some random lady: "FINALLY!"

Mary: "Hi, can I help you?"

Some random lady: "CAN YOU HELP ME? Is that what you just said?"

Mary: "Uh, yes."

Some random lady: "I've been by your office 8 times in the last 2 weeks, and EVERY TIME the door has been locked. WHAT IS THAT SUPPOSED TO MEAN?!!!"

Mary: "Um, well, it means we're closed. We're open weekdays from 7:30 to 5..."

Some random lady: "Excuse me, did you just say it means you're closed?"

Mary: "Yes, we're open from..."

Some random lady: "THAT is completely unacceptable." 

(walks out, slams door)

Succinct

Today I'd like to feature a quote from a friend, that really struck me as spot-on.

He and I were talking about the shitty reviews people leave on rate-a-doc sites, and he said:


"You know, it's really too bad that people get their pre-conceptions of something as important as their medical care from places like Google and Yelp. It's like getting your wine selection from a drunk passed-out on MD-20/20 lying next to the railroad tracks."


Thank you, OC!

Random pictures

Okay, time to hit the mailbag for stuff you guys have sent in.


First there's this restaurant's hours:

Then there's this fairly generic news item, until you get to the end of the 3rd paragraph:

Here's a mouthwash label. Because nothing sounds better than saying it tastes "acceptable:" 

 When "supreme" isn't good enough for your urethra, there's always "supremium."

"Hey, how am I supposed to take this?"

 

Lastly, here's an advertisement for medical lubricant. For the life of me, I have no idea what they're trying to market with this image.

Patient quote of the day

"I know that they know that she knows, but what she doesn't know is that they know I know she knows. You know?"

Acronym FAIL

While the anti-synthetase syndrome is a serious disease, it really needs a better acronym. As this slide from an educational conference shows:

Thank you, E!

Guessing

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

Mr. Clueless: "Hi, this is Sid Clueless. I saw the doctor last month, and he ordered a bunch of tests. I had them all done several weeks ago, but nobody has called me with the results."

Annie: "I'm sorry about that, sir, let me check your chart."

Mr. Clueless: "It's ridiculous that you didn't try to reach me. I've been waiting all this time, and my wife and I are both really worried."

Annie: "I understand... Sir, I'm not finding you anywhere in our system. When did you see Dr. Grumpy?"

Mr. Clueless: "On July 27, 2017."

Annie: "You're not on the schedule for that day. Maybe you saw a different doctor?"

Mr. Clueless: "No, I definitely saw Dr. Grumpy. I know your building. It's the one with an elevator."

Annie: "Sir, that describes pretty much every medical building out there."

Mr. Clueless: "It's the one on Central and 74th Street, by the Sam Gross Cartoon Museum."

Annie: "We're all the way across town from there."

Mr. Clueless: "Oh... Maybe I didn't see Dr. Grumpy then. Can you still give me my results?"

Annie: "We don't have access to other doctor's charts."

Mr. Clueless: "I thought they were all in the computers you guys use."

Annie: "No, it doesn't work like that, sir."

Mr. Clueless: "Can you at least tell me which doctor I saw?"

Annie: "We don't know that, either."

Mr. Clueless: "Crap. Now I have to wait until my wife gets back from the store."

August 25, 1950

The U.S.S. Benevolence was a full-sized hospital at sea. She had 802 beds, many operating rooms, and the most up-to-date X-ray and lab equipment upon her completion in May, 1945.

She sailed to the Pacific, serving in the closing months of World War II. The casualties of the island-hopping strategy were terrible, and she took care of many as the allies closed in on the Japanese home islands.

At the Japanese surrender she was anchored in Tokyo bay, hidden behind the American and British battleships. Although hospitals don't get the glory that fighting ships do, they're still an indispensable part of any naval force.

After the big ships were gone, the Benevolence got down to work. 1,520 allied prisoners-of-war were released to her care, with her crew nursing them back to health so they could go home. She stayed in Japan until late November, 1945, doing this vital work.

The next month she sailed for San Francisco, bringing those too wounded to leave their beds back to the U.S. for further care. She spent early 1946 running back-and-forth between there and Pearl Harbor, transporting more injured home as they were brought in.

Later that year the atomic bomb testing was planned for Bikini atoll, and the Benevolence was selected to provide medical care for the operation. She served in this capacity through the entire project, and was then sent to provide hospital services in Tsingtau, China, anchoring there in October, 1946.

In 1947 she returned home and went into reserve, but was recommissioned and modernized in 1950 to serve in the Korean war.

On August 25, 1950, she was running sea trials off San Francisco before being sent overseas. She was 4 miles west of the Golden Gate Bridge, returning to harbor in a heavy fog.

A freighter, the S.S. Mary Luckenbach, was also blundering through the haze that afternoon, and just after 5:00 the two collided.

The Luckenbach was the less damaged, and anchored nearby to assess what had happened. Due to the fog her crew were initially unaware that the Benevolence was sinking rapidly, but as distress signals came in they manned their own lifeboats to go help. They saved 85 lives in the growing darkness.

The Benevolence was completely gone in just 15-20 minutes.

A makeshift rescue armada raced to the scene as night fell. Coast Guard ships, fishing boats, tugboats, pleasure craft, and merchant ships slowly moving through the murk, listening for voices, shining searchlights, and sending their own lifeboats back and forth to get swimmers. With the tide going out some survivors were miraculously found 12 miles west of the sinking, up to 6 hours later. One was floating on a wooden box of blood plasma.

As they returned to port almost every ambulance in the bay area was on the scene, taking them to hospitals and returning for more.

When it was all over 505 had survived and 23 were lost.

Both captains were faulted for excessive speed in the fog. The new radar technology on the Benevolence had somehow not seen the Luckenbach, and the Luckenbach's own set was malfunctioning and was turned off at the time.

When the sun came up and the fog cleared the next morning, the ocean off Golden Gate had an eerie sight: The 71 foot-wide Benevolence, lying on her side in 75 feet of water, with her red cross insignia clearly visible beneath the waves.

The navy surveyed the wreck for several months before deciding she was beyond salvage. She couldn't be left in the center of a busy shipping lane indefinitely, either.

In late 1951 the Benevolence was completely destroyed in a series of 3 controlled explosions to clear the area.

To this day she remains sadly forgotten, with no memorial to remember those lost that afternoon.

Words

 

“Train wreck,” for the uninitiated, is medical slang for a patient with EVERYTHING wrong.

Example: “Mr. Smith in the ICU, room 17, is a train wreck. He has metastatic cancer and advanced renal disease. He was getting dialysis yesterday when he suffered a heart attack and then went into respiratory failure. He’s on a ventilator now, and has developed sepsis.”

Anyway

One day back in residency we were doing our usual morning rounds, presenting cases to the attending. My friend Zack was telling him about a guy he'd admitted the previous night.

Zack: “Okay, the next one, in ICU room 7, is a train wreck. He…”

Dr. Proper: “NEVER SAY THINGS LIKE THAT! Patients are people, and I don’t want to hear slang! Present the case to me in medical terms."

Zack: “I'm sorry, but I mean…"

Dr. Proper: “STOP! Let’s try this again. Why is the man in room 7 in the hospital?”

Zack: “Um, he was driving his car and was hit by a train."

Seen in a chart

As opposed to?

That's all the line said about it, folks. I didn't cut anything out.

My readers write

A 2nd year internal medicine resident sent this in:

I was doing night admissions, and one was an elderly lady who'd come in for a hip fracture. The ER doctor told me the ortho surgery resident had already seen her, but there was nothing in the chart to tell me what the plans were.

So I called the ortho resident to touch base.

Dr. Dudebro: "Ortho, returning a page."

Me: "Hey, I'm the medicine resident admitting Mrs. Hip. You evaluated her in ER a few minutes ago?"

Dr. Dudebro: "Oh yeah, with a broken hip! What's up?"

Me: "What's the plan for her?"

Dr. Dudebro: "Uh...she needs surgery."

Me: "Right, but what's your plan? When are you planning to take her?"

Dr. Dudebro: "Uh...I don't know. She needs surgery."

Me: "Okay, but she's on Coumadin and is therapeutic. Are you taking her to OR tonight, and I need to reverse her ASAP? Or is this less urgent, and I can just give her vitamin K and manage her pain until you're ready for her?"

Dr. Dudebro: "Uh...she needs surgery."

Me: "Never mind. I'll figure it out."

- Thank you, R!


And for those of you who remember:

Summer fun

I'm at work.

Mrs. Grumpy is out of town with the twins.

Frank is at home alone. He's 17, so should be able to survive for a few hours on his own, right?

Then, while I'm with a patient, this text from him shows up:

Breaking news!

From around the world, Dr. Grumpy's reporters bring you the stories that shape our lives.


DATELINE: Durango.

A bear broke into a parked Suburu SUV and took it for an early-morning spin.

The unidentified ursid, who's still on the loose, smashed a window and climbed in. From there it released the parking brake and went rolling down the street.

During its brief ride the bear drove over some utility boxes before finally going into a yard and hitting a mailbox. The homeowner, Mr. Ron Cornelius, was woken by the noise and called police. When asked about the early hour, Mr. Cornelius said "Usually, I don’t get up at 5 o’clock unless there is a bear driving a car down the street."

Apparently unhappy about its short ride, the bear destroyed the interior of the vehicle. It pulled the steering wheel off the shaft, ripped the radio out, and broke the back window.

Originally it was thought to have been the work of human vandals, but the bear's involvement was confirmed by the extensive degree of damage wrought and, more importantly, a large pile of bear shit that had been left inside the car.

So there you have it: Bears do shit in the woods, but in a pinch will use a Subaru.



DATELINE: Olympia.

A traffic jam was caused by a dead body rolling down the street.

Police said an ambulance transporting a dead body had its back door open while moving. Two gurneys, one with a recently deceased occupant, fell out and went speeding down the street.

The driver, unaware of this turn of events, continued on his way.

The gurney with a body stopped in an intersection, forcing police to re-route traffic through the area until coroner's staff could arrive to take the escapee into custody.

The empty gurney was found in a parking lot.

Neither gurney, nor the deceased, was damaged during the joyride.




DATELINE: Sioux City.

Police were called when a man attempted to deposit a fake $1 million dollar bill into his bank account.

Upon arriving to the bank, police officers interviewing the fellow asked if he had any more of the million dollar bills on him, whereupon he pulled a bag of methamphetamine out of his pocket.

Somewhat comically, he's being held on a $1,000 bond.

Police suspect drugs were involved.

"It's for the neurologist. You know how he can be."

A nurse writes that, when she arrived to work yesterday, this was the state of the galley fridge at her ICU:

Thank you, J!

Annie's desk

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

Lisa: "Hi, this, is Lisa, referral person for Deathtrap HMO."

Annie: "Hello."

Lisa: "Dr. Grumpy referred Mr. Axon to Dr. Needlemeister for an EMG? I thought Dr. Grumpy does these himself."

Annie: "He does, but Mr. Axon has a number of issues that make the test more complicated. So Dr. Grumpy prefers that an EMG specialist do it in this case."

Lisa: "Okay, but if Dr. Grumpy has another doctor do it, I want to make it clear that we will not pay Dr. Grumpy for the test. We'll pay that doctor instead."

Annie: "Of course. We wouldn't expect you to pay us for it."

Lisa: "You people are so weird."

Covering all the bases

Seen in a chart:

Thank you, C!

Summertime

It's Saturday afternoon. As I'm heading home from the hospital, Mrs. Grumpy texts me to get some tomatoes at the grocers and to pick up my Sarcasma at the pharmacy before she has to kill me.

I'd been at Marie's basketball game when the hospital called, and so was wearing an old Motörhead T-shirt. While waiting in line at the grocery store some guy came over.

Some Guy: "Hey, I like that T-shirt."

Dr. Grumpy: "Uh, thank you."

I'm generally not one for small talk, so stared at my iPhone and began checking email. Unfortunately, this didn't stop him.

Some Guy: "I'm a big Motörhead fan. I saw them in person back in the day."

Dr. Grumpy: "Cool."

Some Guy: "I love their stuff. I was busted up when Lemmy died. You know, I don't think I've ever seen that particular T-shirt. Where'd you get it?"

Dr. Grumpy: "Uh, don't remember." (Actually, I'm pretty sure I got it at the charity thrift store for $1)

(I texted Mary asking her to call me so I can answer my phone)

Some Guy: "How much do you want for it?"

(He didn't really say that, did he? I'll just keep staring at my phone.)

Some Guy: "I like it. How much do you want for it?"

(For a fleeting second I think about it. I paid $1 for it... Ask him for $40 and see what he says.)

Dr. Grumpy: "No, thank you. Then I'd have nothing to wear home, and I still have errands to run."

Some Guy: "That's easy. I'll give you mine."

I look at him. He's wearing a white wife-beater undershirt with food stains and probably more antibiotic-resistant organisms than an uncleaned colonoscopy tube.

Dr. Grumpy: "Uh, no thanks."

(Mary texts me back, asking how much a call is worth to me)

Some Guy: "Your loss, dude."

He walks off. I got the tomatoes and headed over to the pharmacy. While in line there...

Some Guy: "Hey! It's you again. Did you change your mind? I came by to get some condoms. I'm still willing to switch shirts."

Dr. Grumpy: "No, thank you. I'll keep this one."

(The other people in line are looking at both of us like we're street performers)

Some Guy: "I've got a sort-of cleaner T-shirt in my car, I'll throw that one in, too."

Pharmacist: "Next in line, please."

It's my turn. Thank heavens.

Back next week!

We're still dragging kids around (and vice versa).

Off, again

Heading out for our big trip of the summer.

3 kids, lots of relatives, and our credit cards.

See you in a few weeks!

Memories...

Back in residency, I occasionally had to round with Dr. Levodopa on weekends.

Dr. Levodopa, in a field of pathological personalities, had more odd mannerisms than I could count. But his strangest was that he carried a cup of black coffee... in his white coat pocket.

Not a travel mug, or even a generic cup with a plastic lid on it. But an open styrofoam cup. He'd fill it about 3/4 to the top at the nurses station, take a few sips, shove it in one of the coat's lower pockets, and start rounds.

So he had a large collection of white coats, all with dark coffee stains running from the right front pocket to the hem. As he'd walk, or move, or cough, coffee would slosh out, running down his white coat, pant leg, and to the floor. He never seemed to notice.

He was, though,  clearly aware of it, because he'd change into a clean coat as soon as he got to his clinic.

Like in "The Hitchhiker's Guide to the Galaxy," the resident on rounds with him would carry around a large towel (we kept several old ones in the call room for this purpose) to keep the floor from being slippery and wet as Dr. Levodopa wandered to and fro. He was, as best we could tell, completely oblivious to our efforts. Or, more likely, just didn't care.

25 years later... and I still don't understand why he did this.

Not particularly helpful

Seen in a chart. Apparently, death is a diagnosis, and it has a 100% chance of running in families.