Monday, July 22, 2019

Communication

I'm sitting in my office with an elderly lady with Alzheimer's disease and her devoted son.


Dr. Grumpy: "So how's she been doing?"

Mr. Son: "Better, at least a little. I mean, her memory is still pretty bad, but she's calmer, and the nurses tell me she's more cooperative and isn't yelling since you started the new medication."

Dr. Grumpy: "Has she..."


Mr. Son's phone rings and he looks at it.


Mr. Son: "I better answer this, it's Casa DeMentia, her memory-care place. I'll put it on speaker phone in case you want to ask them anything... Hello? This is Mr. Son."

Susan: "Mr. Son, this is Susan. I'm the charge nurse at Casa DeMentia. I'm calling to let you know that your mother isn't in her room, and we've searched the building and grounds thoroughly and can't find her. We're afraid she somehow wandered off..."


Mr. Son and I both look at the patient, who's calmly sitting in my office leafing through an upside-down magazine.


Susan: "... so our security people are going to review video to see what happened, but I wanted to make you aware. I'm going to call the Grumpyville police for a Silver Alert, too, and..."

Mr. Son: "Um, my Mom is right here with me. We're at Dr. Grumpy's office. I signed her out at the front desk when I picked her up."


Pause.


Susan: "Cindy, before you told me Mrs. Memory was missing, didn't you check the sign-out book first... WHY THE HELL NOT? You (expletive)."


Pause.


Susan: "I'm so sorry to bother you Mr. Son. Will she be back for lunch?"

Thursday, June 27, 2019

Heading out

It's summer vacation time, gang.

I'll be heading out for a few weeks with my wild bunch.

Back sometime in the second half of July.

Until then, have a great summer. Or, if you're reading this from the southern hemisphere, have a great winter.

And so it begins.



Monday, June 24, 2019

Seen in a chart


Thank you, K!

Thursday, June 20, 2019

Patient quote of the day

"I was watching health news on TV this morning. Did you know you can die if your heart isn't working right?"

Monday, June 17, 2019

Humor

Three elderly ladies are sitting on a bench outside the nursing home when an older gentleman walked by.

One of the ladies yelled out, “Hey, I bet we can guess how old you are!”

The old fellow said, “There is no way you can guess my age! I look great for my age.”

One of the women said, “Yes we can!”

“No, you can’t!”

“Can! Just drop your pants and undershorts and we'll tell your exact age.”

The gentleman was embarrassed, but wanted to prove they couldn't do it. So... he dropped his drawers and let it all hang out.

The ladies asked him to turn around a few times while they looked from different angles, then had him jump up and down twice.

They then whispered back and forth for a minute, and finally one said. “You're 87-years-old.”

The fellow was stunned. Standing with his pants down around his ankles, he asked, “You’re right. WOW! How in the world could you tell?”

There was a pause, then one woman answered “Last week we were all at your birthday party.”


Thank you, Webhill!

Thursday, June 13, 2019

Seen in a chart


Monday, June 10, 2019

Annie's desk

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

Mrs. Faa: "Hi, this is Mrs. Faa. I was hoping you'd be able to help me."

Annie: "Sure... let me just pull your chart up... Okay, what's up?"

Mrs. Faa: "How do I get blood out of my carpeting?"

Annie: "Uh, well, hydrogen peroxide, or..."

Mrs. Faa: "No, I mean, do you know a good carpet cleaning company in my area? I broke a glass in the kitchen, and then stepped on a big shard while trying to clean it. So there's blood everywhere from when I walked to my bathroom to get a band-aid. It's a mess."

Annie: "Well, I don't know who's in your part of town, but let me look some up."

Mrs. Faa: "I bled A LOT. I mean, literally, all the blood has been drained out of my body. I have no blood left in me at all. It's all on the carpet."

Annie: "Do you need to go to ER?"

Mrs. Faa: "Why? Will someone there help me clean it up?"

Thursday, June 6, 2019

June 6, 1944



"There have only been a handful of days since the beginning of time on which the direction the world was taking has been changed in one 24-hour period by an act of man. June 6, 1944, was one of them.

"No one can tell the whole story of D-Day. Each of the 60,000 men who waded ashore that day knew a little part of the story too well. To them the landing looked like a catastrophe. Each knew a friend shot through the throat, shot through the knee. Each knew the first names of five hanging dead on the barbed wire offshore, three who lay unattended on the beach as the blood drained from the holes in their bodies. They knew whole tank crews who drowned when their tanks were unloaded in 20 feet of water.

"There were heroes here no one will ever know because they're dead. The heroism of others is known only to themselves.

"What the Americans and the British and the Canadians were trying to do was get back a whole continent that had been taken from its rightful owners. It was one of the most monumentally unselfish things one group of people ever did for another.

"It's hard for anyone who's been in a war to describe the terror of it to anyone who hasn't. How would anyone know that John Lacey died in that clump of weeds by the wagon path as he looked to his left towards Simpson and caught a bullet behind the ear? And if there had been a picture of it - and there weren't any - it would've shown that Lacey was the only one who carried apples for the guys in his raincoat pocket.

"If you think the world is rotten, go to the cemetery at Saint-Laurent-sur-Mer on the hill overlooking the beach. See what one group of men did for another, D-Day, June 6, 1944."

- Andrew Rooney (1919-2011)

Monday, June 3, 2019

Phone

Betty Tau: "Hello?"

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

Betty Tau: "Dr. Grumpy isn't here."

Dr. Grumpy: "Hi, Betty, this is Dr. Grumpy. Did your daughter call me?"

Betty Tau: "Dr. Grumpy isn't here. You have a wrong number."

Dr. Grumpy: "Betty, is your daughter there?"

Betty Tau: "No, but I think she was trying to reach Dr. Grumpy. Do you know him?"

Dr. Grumpy: "This is Dr. Grumpy, returning a call for your daughter. Why don't you put her on the phone?"

Betty Tau: "I told you, Dr. Grumpy isn't here. You'll need to ask my daughter what his phone number is. She handles those things. If you want Dr. Grumpy you should call his office and leave us alone."

click

Tuesday, May 28, 2019

"Grandma, what did you bring me?"

This fellow was being handed out at the recent immunology meetings.




Thank you, M!

Thursday, May 23, 2019

Criswell predicts

Dr. Grumpy: "Okay, so I'll have Annie set up the MRI for you, and then..."

Ms. Dixon: "What do you think it will show?"

Dr. Grumpy: "It's hard to say. I don't think there's anything of alarm, but with your symptoms I'd like to make sure I'm not missing anything."

Ms. Dixon: "So you really aren't sure?"

Dr. Grumpy: "No, that's why I want to get the test."

Ms. Dixon: "This is kind of disappointing. I thought you'd be able to tell me what it would show, that way I wouldn't need to have it in the first place."




Sunday, May 19, 2019

One of these things is not like the others


Monday, May 13, 2019

Short visit

Seen in a chart:


Thursday, May 9, 2019

Cancellation

Mary: "Hello, this is Mary from Dr. Grumpy's office. I wanted to confirm Mr. Lumbar's appointment tomorrow with Dr. Grumpy."

Mrs. Lumbar: "Oh, he won't be coming in. The back pain doesn't bother him anymore."

Mary: "Oh, okay, well I'm glad to hear that."

Mrs. Lumbar: "He's dead."

Tuesday, May 7, 2019

History reruns

May 7, 1915





Today in history, in a factoid well known to school children, the R.M.S. Lusitania was sunk by a German submarine with a loss of 1198 lives.

And... that little snippet is pretty much all most people know about the disaster.

The details are forgotten compared to her erstwhile competitor, Titanic. Nobody made a blockbuster movie about her. Plenty of books have been written, but they often focus on the debated aspects. Was the ship a legitimate target? Did the British admiralty intentionally put her in harm's way? Was she carrying priceless paintings? These questions will never be settled, and I won't debate them here.

Americans are taught that the sinking is what brought the U.S. into WWI. Horseshit. It certainly contributed, but was only a small part. In fact, President Wilson fought like hell to stay out afterwards, and the U.S. didn't enter the war for another 2 years. The resumption of unrestricted submarine warfare in 1917 was a bigger factor. And, although mostly forgotten now, the Zimmerman Telegram was likely the event that finally pushed America into hostilities. Except for those of you who (like me) are fascinated by history, you've probably never heard of it.

A voyage then was a far cry from cruising now. Today's ships are designed for entertainment, with shows, games, shopping malls, climbing walls, mini-golf courses, and countless activities. They're rarely at sea for more than 2-3 days (at most) and frequent port stops are part of the attraction.

That wasn't the case in 1915.

To get some idea of intercontinental travel in the pre-flight age, think of this: You were in a large hotel for 10-20 days. You couldn't leave. You didn't stop in port until the end. The restaurants, though opulent, were the same. Your fellow travelers, and the crew, never changed. The only entertainment provided by the ship were small orchestras for 1st and 2nd class, an exercise room, and a meager library. 3rd class slept in large dormitory-like rooms that doubled as their dining areas, and their only entertainment was whatever instruments and reading they'd brought. The North Atlantic crossing, arguably the busiest and most economically important of the era, was rainy, cold, and windy. The ships didn't have the stabilizing systems we take for granted today, and rolled with the choppy seas.

The Lusitania's stories are mostly forgotten (like the Empress of Ireland) probably because of the time scale involved. From start to finish the sinking took 18 minutes. In that sort of time, on a rapidly foundering ship, the overall reaction is rushed panic. The Titanic, in contrast, floated for 2 hours and 38 minutes after striking the iceberg. Enough time to avoid panic and for the norms of Edwardian society to dictate the events. Women and children first. Rich before poor. Americans & Britons before immigrants. Stories of the band playing to the end, of Isidor & Ida Straus choosing to die together rather than get in a lifeboat ahead of younger people, or the chief engineer who went back to carry out a crewman with a broken leg - with neither ever seen again. Thousands of stories in 158 minutes that immortalized the disaster.

In just 18 minutes, those on the Lusitania didn't have time to do much but try to get in a lifeboat. Most failed. Although (unlike the Titanic) she had enough lifeboats for all, the slope of the sinking hull, and the rivets holding it together, made it difficult to launch them. Many dumped people out before hitting the water.

But stories are there, you just have to look for them.

The Lusitania herself was a technological marvel. The first liner fitted with the revolutionary new steam turbines that today run everything from nuclear submarines to power plants. The first ship to have a central climate-control system (the ancestor of air-conditioning) to keep the interior at a steady 68°F, regardless of outside weather. The system also exchanged the air inside the ship 7 times every hour, eliminating the need to open portholes on a cold day. And, for a time, she was the fastest liner to ever cross the Atlantic.

On the antagonist in the tragedy, the submarine U-20, was a story. The ship had been identified as a large passenger liner, and Kapitanle├╝tnant Walther Schwieger still had every intention of sinking her. He gave the order to fire, and it was the job of Quartermaster Voegele to relay it to the torpedo room.

But Voegele wouldn't. He told Schwieger he refused to carry out an order that would kill innocent civilians. Schwieger immediately relieved him of his post and had another officer do it. After returning to land, Voegele was court-martialed and spent the rest of the war in prison.

Very few stories are as popular, or been "re-booted" as much, as Peter Pan. From the Walt Disney cartoon, to Dustin Hoffman's "Hook," to 2003's "Neverland," the tale has been imagined and re-imagined, both in movies and theater, many times. And Tinkerbell now has her own spin-offs.

But the odds are you'd never have heard of Peter Pan or Tinkerbell if it weren't for a man named Charles Frohman. One of the leading theater producers of the era, he was instrumental in bringing the story to stage. First in London, then in America, he put J.M. Barrie's once obscure story in front of live audiences night after night. Frohman even had the title changed, from the original "Peter Pan - the Boy Who Hated Mothers" to the one you know: "The Boy Who Never Grew Up." It's as immortal as a tale can be.

Frohman died on the Lusitania, at age 58. Unable to jump into a lifeboat due to severe arthritis, and not knowing how to swim, he knew his life was coming to a close. He spent his last minutes with the wealthy Alfred Vanderbilt (age 37, also couldn't swim, and refused to get in a lifeboat ahead of women), tying life jackets to the nursery's baby baskets to make sure the infants would float. As the end approached Frohman turned to actress Rita Jolivet (who survived), and quoted from Peter Pan “Why fear death? It is the most beautiful adventure that life gives us." Then he disappeared under a surge of water.

As Margaret Mackworth and her friend Dorothy Connor watched the frantic rush for the lifeboats, Margaret commented that "I've always thought a shipwreck was a well-organized affair." Dorothy replied "so have I, but I've learned a devil of a lot in the last 5 minutes." An hour earlier, at lunch, Mackworth had told others at her table "It's been such a dull, dreary, stupid, trip. I can't help hoping that we get some sort of thrill going up the channel."

In Chicago, Illinois is Ambrose Plamondon Elementary School. Mr. Plamondon was a major American steel industrialist of the 19th century. When he died his son Charles took over the vast company... And, along with his wife, died on the Lusitania.

Another survivor who ran down to get her lifebelt remembered passing an open door, where inside a middle-aged woman cheerfully arranged and re-arranged her suitcase unconcernedly, as though they were about arrive in port.

In New York, Cunard's local director watched a crowd gather outside his office as news drifted in. He remembered watching a similar crowd outside the rival White Star Line office across the street 3 years earlier, hoping it would never happen to him.

The worst of human nature was on display that night through America, Ireland, and Britain. Mobs attacked and burned business and homes owned by families of German descent, or even those with vaguely German-sounding names.

To the people of Queenstown (now Cobh), Ireland, fell the rescue. As the first S.O.S. crackled from the Lusitania, local fisherman (who'd just come in to unload from the morning) frantically untied their boats and headed back out to sea to save as many as possible. It was a motley collection of mostly sailing boats, a few faster ones with engines, and even some that were being paddled. Boys standing on the cliffs of Kinsale to watch her pass saw the explosion, and helped spread the alarm to local life-saving patrols. The exhausted fishermen worked into the evening to save as many as they could.

As the 767 survivors came into town on overloaded boats, the townspeople rushed blankets and food to the docks. They found places to shelter the fortunate ones - in homes, hotels, warehouses... anywhere there was space - until Cunard was able to make arrangements.

To the locals also fell the unenviable job of handling bodies that were picked up by boats or washed ashore for the next several weeks. Those that could be identified were sent home, but many were beyond that. So three large mass graves, with coffins stacked 2-3 high (some with 2 children put in them) were dug at the Old Church Cemetery. More were buried in Kinsale, at the Church of St. Multose.




Some of the victim's names were known only to their families, sadly being listed on the roster just as "Mr. Stanton's manservant" or "Lady Adam's maid."

In 1912, as the Titanic was about to leave port, the suction from her powerful propellers pulled another liner, the S.S. New York, away from the dock. The 2 ships missed colliding by roughly 3 feet before tugboats could push them apart. Now, 3 years later, the New York was linked to another tragedy. The American government chartered her to bring citizens, living and dead, back to the states. She carried the bodies of Charles Frohman, the Plamondons, and many others.

Survivor Herbert Ehrhardt took off his shoes and gave them to a shivering man in his lifeboat while awaiting rescue. They didn't quite fit, but the man said they'd do. The next day Ehrhardt (and many others) went to a Queenstown shoe store to replace them. As he waited to be helped, he noticed his original pair lying discarded on the floor. He laced them back on and left.

U-20, the submarine that sank Lusitania, ran aground off Denmark in November, 1916, and was subsequently demolished. What's left is roughly 1200 feet from shore, under sediment. The conning tower was removed and is at a local museum.

Captain William Turner of the Lusitania survived the sinking when a wave washed him off the bridge. He was pulled from the water, unconscious, by the crew of a fishing boat. Although exonerated by the inquiry, public opinion held him to be at fault for not taking preventative measures. His wife and sons left him, and he never saw them again. He was assigned to command the ship Ivernia in 1917, which was sunk in the Mediterranean by a submarine. He survived again, but never returned to sea and died in 1933.

Kapitanle├╝tnant Walther Schwieger was killed in September, 1917, when his next submarine struck a British mine.

The last survivor of the Lusitania, Audrey Lawson-Johnston, died at age 95 in 2011.

The once-beautiful Lusitania lies, collapsed on her starboard side, in 300 feet of water off Ireland. While the bow section of the Titanic still evokes a sense of grace and majesty, the Lusitania is little more than a large scrapyard. Her much shallower depth makes her susceptible to the effects of tide, weather, and temperatures. The attack by U-20 was also just the beginning. Countless times in WW1 and WW2 there was concern U-boats were using the wreck to hide, and so it was aggressively depth-charged by destroyers to scare them off.

The hundreds in the mass graves, whose identities will never be known and whose families never saw them again, are marked at the Old Church Cemetery by a single large stone.




Monday, May 6, 2019

Quote of the day

"I was in the ER last weekend for a seizure. They said my Dilantin level was 8. Or maybe it was 18, or 28. I don't know, it was a number with an '8' in it. Does that help?"

Thursday, May 2, 2019

Anatomy

Garlic, like a lot of old dogs, is covered with random lumps, bumps, and warts.

This past weekend Craig was having a party (actually, Craig seems to have a party every weekend, but that's another post).

As usual, Garlic and Onion were making the rounds, hoping to snag a pretzel or fallen cocktail weenie. At one point one of Craig's entourage groupies harem friends began petting Garlic, so he hopped up on the couch next to her to keep the attention coming.

A few minutes later she noticed me wandering out of my office to get a Diet Coke and came over to ask...

"Hi, uh, Mr. Craig's dad. How come your dog has nipples growing out of his back?"




Monday, April 29, 2019

Check out

I was on call for the weekend, so Sunday night had the usual check-out call with Dr. Cortex:


Dr. Cortex: "Hello?"

Dr. Grumpy: "Hi, it's Grumpy."

Dr. Cortex: "Okay, let me get my list and a pen..."

Dr. Grumpy: "How was your weekend? You guys do anything?"

Dr. Cortex: "We took the grandkids to the annual air-show, but, one of the planes crashed while landing. They said the pilot was killed and the passenger badly injured. Fortunately, we were at the snack bar when it happened, so Billy and Dolly didn't see it. But it must have been horrible. We left right away."

Dr. Grumpy: "I don't blame you."

Dr. Cortex: "All right, I'm ready for the list. What have you got for me?"

Dr. Grumpy: "Okay. In the ICU, room 37, is a guy with a serious head injury. He was a passenger in a plane at the air show......."

Thursday, April 25, 2019

Thud

Dr. Grumpy: "Did you have those labs done?"

Mr. Siphonaptera: "Hell no. I walked out of the lab. They treated me like crap."

Dr. Grumpy: "What happened?"

Mr. Siphonaptera: "The girl at the front desk told me she was going to have me see a phlebotomist, which is bullshit. I don't have fleas. So I left."

Monday, April 22, 2019

11:38 p.m.

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

Ms. Papaveraceae: "Hi, I'm a patient of Dr. Brain's, and I ran out of Percocet. My pharmacy number is..."

Dr. Grumpy: "I'm sorry, but I don't call in controlled drugs after hours. You'll have to contact Dr. Brain's office on Monday."

Ms. Papaveraceae: "But I really need it!"

Dr. Grumpy: "I can't call in any narcotics. What I can call in is..."

Ms. Papaveraceae: "But I can't take anything else because of religious reasons. I belong to a small sect that worships poppy flowers, so..."

Dr. Grumpy: "I'm not calling narcotics in."

Ms. Papveraceae: "So you're discriminating against me on the basis of my religion? I will get an attorney and..."

Dr. Grumpy: "Have a good night."

Click.

Thursday, April 18, 2019

Relevant

Last week I received a letter from a research company, looking for "experts in a specific field."

It asked if I could answer "yes" to any of the following questions:



Monday, April 15, 2019

In Memoriam



 
My kids have now passed one of the milestones of modern adolescence.

The death of your first car.

The boys aren't having much of an issue with this, but Marie is taking it vary hard. The 4Runner was her baby.

You may remember her adventures with the car, when she outraced her older brothers to be the first with a license. The Toyota was 19 years old, with 265,000 miles, but she loved it. For reasons known only to her she named it "Dakota," which she insisted on spelling "decoda."

And, fittingly, it died with her at the wheel.

Rolling down the freeway on her way to an off-campus class, it suddenly began shaking wildly under her and making a racing noise. Alarmed, she took her foot off the gas and started to pull into the emergency lane. Then there was a loud "BANG!"

The engine stopped, never to turn again. As she came to a halt, Marie noticed a lot of fluid and some pieces of metal in the road behind her.

Since nothing fazes Marie, she calmly called AAA to arrange a tow, only bothering to notify her parents of this change in events when AAA asked where they should haul the car.

The next morning the guy at the car place asked if I could swing by on the way to work. Taking me into the garage, he showed me a jagged hole in the engine block the size of a football. As I marveled at it he handed me a chunk of metal that used to be piston, and pointed out where he'd found it embedded in the undercarriage.


I thought it looked like a femur. Keys are for size comparison.


So, after circling the globe 10.5 times, the car is being donated to charity.

We went to the repair shop before it was towed away to strip it of our personal stuff. This included $5.82 in coins scattered in cup holders, seat cushions, and under floor mats.

Marie carefully pried the 4Runner nameplate off the back, and it's now hanging in her bedroom, next to the hunk of piston.

Thursday, April 11, 2019

I'd have to agree

I'd just finished doing an EMG/NCV on a patient.


Dr. Grumpy: "I hope that wasn't too bad."

Mr. Needle: "Nah, it went fine."

Dr. Grumpy: "Good."

Mr. Needle: "Yesterday they stuck a camera up my dick. That was much worse."

Monday, April 8, 2019

Seen in a chart.

If this MRI finding is correct, it's a publishable case.


 

Thursday, April 4, 2019

My readers write

I'd like to thank the person who sent in this allergy list:


"Really? I have more trouble with their teeth and claws myself."

Monday, April 1, 2019

You don't know jack

NOTE: the following is NOT an April Fool's Day joke.

I'd like to thank the Science Marches On Department for sending me a truly remarkable piece of research.

Scheduling in a medical clinic requires talent, skill, and magic. There's only so much time in a day, and a lot of patients who need to be seen. People often portray the front-desk wizards as brainless, but they're far from it. Mary, after 14 years, knows me and my patients. From a few seconds on the phone she can get a good idea of how much time any particular patient will need, how that meshes in with the rest of my schedule, and (based on history) how long I am with any given return.

She also has to figure in how long it take takes me to grab a Diet Coke and drain a previous one between visits.

Any practice faces this issue, so obviously some research goes into improving work flow.

A study out of Miami, Florida recently looked into this important subject to calculate times needed for appointments at a fertility clinic.

Specifically, how long it took for a guy to, uh, shake hands with the milkman.

Yes, they wanted to know. That.

In the study guys were given a donation cup and unnamed porn mag. A stopwatch was started at the time they entered the room. They then took matters into their own hands, and texted "done" to the stopwatch person after the research project had climaxed.

For privacy, the exam room had a curtain. Boy, that's a relief.

Admittedly, it sure beats the idea of having a burly orderly with a timer in there, watching you box the one-eyed champ, but still.

The study makes no mention if the guys were allowed to wash their hands before picking up their phones to text the desk afterwards.

This graph is, by far, the best part of the article. It shows how long a guy takes to let it fly while pumping gas vs. the number of patients seen that day.


Note the blue bars: some guys actually had their ladies in the room during the process, although, under the fertility protocols, they weren't allowed to have physical contact. So the bottom line is that, if someone is watching you polish the banister, it will take longer to finish the job. In fact, the ONLY guy in the study who was unable to successfully finish marching the penguin was one who had his girlfriend in there.

Who could have seen that coming?

You can read the study itself here. It has pictures of the exam room, and a porn mag with a brown paper cover on it.

Thank you SMOD!


Sunday, March 24, 2019

Spring break

Taking a few days off for kid stuff. See you next week!

Saturday, March 23, 2019

Musical Gobstopper

For those of you who somehow haven't seen the totally awesome SNL "Bodega Bathroom" musical number, here it is. You're welcome.


Thursday, March 21, 2019

11:52 p.m.

I'm sound asleep when my iPhone rings. It's my call partner, Dr. Cortex.

Dr. Grumpy (mumbling, trying to wake up): "This is Dr. Grumpy."

Dr. Cortex: "Hi, it's Cortex."

Dr. Grumpy: "Why are you calling? Aren't you in the hospital for hip surgery?"

Dr. Cortex: "Yeah. Hey, did you round on my patients today?"

Dr. Grumpy: "Yes."

Dr. Cortex: "Did you see the guy in alcohol withdrawal in room 6824?"

Dr. Grumpy: "Yes, why? I think I ordered all the usual tests."

Dr. Cortex: "Because after I left recovery they put me in the room next to him, and he's screaming nonstop and I can't sleep. He's driving me nuts. I'm going to put you on with his nurse now, so you can order something to sedate him."


Monday, March 18, 2019

Seen in a chart

Monday, March 11, 2019

Parenting

I'm at the dreaded Wednesday morning neurology meeting at the hospital. My colleague, Dr. Mom, is sitting next to me.

About halfway through the meeting her iPhone rang. She answered it, listened for a few seconds, then said:

“LOOK, Mr.-I-had-a-Bar-Mitzvah-so-now-I-am-a-man, I don’t care how well you did at your Bar Mitzvah, the fact that you forget your lunch at home - again - still makes you an irresponsible moron in my book and you can shut up and go hungry for the day to learn a lesson and if you call me about this again you’re not getting dinner either!”


Then she hung up.


We fist-bumped.

Thursday, March 7, 2019

Pathetic

You know, it's REALLY PATHETIC that 40 years after this public service announcement first ran, we need it now more than we did then.

Get your kids vaccinated. Don't believe the bullshit out there.




Monday, March 4, 2019

Planning

School competitions always bring a bunch of paperwork, rules, and forms for parents to sign.

This year they included this:



Thank you, A!

Thursday, February 28, 2019

Addendum

I'm with a patient when Mary interrupts me. Dr. Unka, a deranged cardiologist in my building, is on the phone. So I apologize to my patient and pick up the line.

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

Dr. Unka: "Hi, Ibee. You consulted on a hospital patient of mine this morning, Mr. Sah. He's the one who fell and hit his head at home yesterday, and now has a brain hemorrhage?"

Dr. Grumpy: "Yeah, he's in ICU. What's up?"

Dr. Unka: "Well, I was reading your note, and in your dictation it says he slipped on water that was on the floor. I just spoke to his wife, and she's very certain it was iced tea, because he'd just knocked a glass over and was going to get a towel to clean it up when he fell."

Dr. Grumpy: "Um..."

Dr. Unka: "Anyway, I thought it was important you should know, in case you want to amend your dictation."

Monday, February 25, 2019

Breaking News!

From around the globe, Dr. Grumpy's crack team of reporters bring you the stories that shape our world.


DATELINE: WINNIPEG

Diners waiting for burgers in the drive-thru of an A&W restaurant kept waiting, even after it became obvious the restaurant was burning down.

In a remarkable testament to human optimism, brand devotion, and hunger, patrons were, apparently, convinced their dinners would be ready soon. This is in spite of smoke pouring out of the place, employees fleeing the building, and approaching sirens. In fact, more people just kept pulling in. One can only assume they thought the column of smoke was coming from the grill.

It wasn't until a total of 8 firetrucks had arrived that the hungry customers realized they should consider other dining options and left.



DATELINE: CHINA

A man in Zhangzou was hospitalized with fungal pneumonia. The potentially serious disorder has been attributed to his habit of repeatedly smelling his own socks after wearing them all day. He apparently did this as a way to relax after work.

I think I'll stick with a beer.




DATELINE: FLORIDA

Mr. Onelio Hipolit-Gonzalez was arrested for running a bogus medical clinic.

He charged people $160 for an initial appointment, which consisted of them holding a metal rod that was connected to a beeping machine (Ah! the machine that goes "PING!"). Afterwards he'd tell them the machine showed various organ problems and that he could cure them for $2000.

His "cure" for diabetes apparently consisted of him drawing blood and then re-injecting it back into their body.

Mr. Hipolit-Gonzalez was reportedly "shocked" to learn his actions were illegal, and, as proof of his ability to practice medicine, stated he'd been a lab technician.





DATELINE: BRAZIL

Mr. Abdias Melo, who must be a VERY sound sleeper, remained in dreamland while friends super-glued a colorful assortment of dildos to his back.

They then woke him by banging pots together.





Attempts to remove the dildos at home failed, and Mr. Melo ended up going to ER. I suspect even the most hardened team of emergency staff was taken aback by this case.

Either that or he was mistaken for a stegosaurus.

Thursday, February 21, 2019

A really sick horse

Dr. Grumpy: "Any illnesses in your family?"

Mr. Patient: "My mother has smoked a pack a day for 70 years and, except for her lung
cancer and heart failure, is healthy as a horse."

Monday, February 18, 2019

Confessions

You ever killed someone?

I have.

Of course, "kill" is too strong a word for what most doctors have done at some point, but still, he died because of my direct actions (a nurse and respiratory tech were involved, too).

He was a retired farmer, around 80. Strong and healthy for his age. I was in my early 30's, just out of residency and starting life as a newly-minted attending physician.

He'd fallen from a ladder and severed his upper cervical spinal cord. He was awake and alert, but completely paralyzed from the neck down. He couldn't breathe on his own, so was facing the rest of his life on a ventilator, requiring complete care for everything. There was no hope for recovery.

In the first days of the injury the trauma and neurosurgery people worked their magic, stabilizing what was left of his neck, converting him quickly from a ventilator tube to a tracheostomy for comfort, getting a feeding tube in.

As the days went by and we began decreasing his medications it became clear that he would live, was mentally intact, and could communicate with us.

In spite of what his family had told us, he wanted to be let go. He'd led a robust life and didn't want to spend the rest of it in this condition. He was ready to have things turned off so he could pass.

This sort of thing is (comparatively) easy in someone with advanced dementia, or severe brain trauma, or end-stage cancer. But in a guy who was fully awake and who'd been healthy and vigorous a few days earlier it was a whole different matter.

The family was unhappy, but acquiesced to him. To cover myself I had a psychiatrist interview him and ordered a consult from the hospital ethics committee. All agreed that he was pleasant, had a good sense of humor, and was fully capable of making this decision.

The family didn't want to be in the room when it happened, so we gave them all the time they needed to say goodbye.

When the time came we chatted briefly, and he thanked me and the team who'd taken care of him. He even asked that we shake his hand.

I had the nurse give him megadoses of morphine and Ativan, to put him to sleep and take away any pain that might still be there. Once he was out the respiratory tech disconnected him from the ventilator. Between the medications and his non-functioning diaphragm he went pretty quickly. I wrote a death note and moved on to another case. There are always more consults.

What would you call it? An execution? Physician-assisted suicide? Compassion? I'm sure some out there would love to have me tried for murder, but I don't care.

To me, my responsibility is to the patient. This man had lived a good life, wasn't suicidal in the sense of someone who's depressed, and made a rational decision about his own existence. I did everything I could to make sure there wasn't a good reason NOT to end his life, and did what I could to respect his wishes and relieve his suffering.

That was the first, though not last, time I've had to face this situation. We may become more experienced, but it never gets easier.

It's been 20 years, and I'd still say the same thing: In the end it wasn't my decision, it was his. I just did what was right for the patient.

Thursday, February 14, 2019

Neurology humor

Two neurologists were walking along the street when they saw an old-timer veteran cop walking a beat with his legs wide apart. He was stiff-legged and walking slowly. One doctor said to his friend: "I'm sure that poor old cop has Peltry Syndrome. Those people walk just like that."

The other neurologist says: "No, I don't think so. The old cop surely has Boyd Syndrome. He walks slowly and his legs are apart, just as we learned in training."

Since they couldn't agree they decided to ask the cop. They approached him and one said, "We're neurologists and couldn't help but notice the way you walk, though we couldn't agree on the syndrome you might have. Could you tell us what it is?"

The old-timer said, "I'll tell you, but first you tell me what you two fine upstanding neurologists think." The first doctor said, "I think it's Peltry Syndrome." The old-timer said, "You thought - but you are wrong." The other neurologist said, "I think you have Boyd Syndrome." The old cop said, "You thought - but you are wrong."

So they asked him, "Well, old timer, what do you have?"

The old-timer cop said, "I thought it was just a fart- but I was wrong, too!"

- Thank you, Officer Cynical!

Monday, February 11, 2019

Friday morning, 12: 38 a.m.

This message, left on the on-call emergency voicemail, woke me up:


"Dr. Grumpy, you can cancel all my appointments. I'm very hurt. This is the 2nd year that your lousy practice hasn't sent me a birthday card, like my dentist does. I think you're an asshole. Goodbye!"




Thursday, February 7, 2019

No kidding

Dr. Grumpy: "Are you allergic to any medications?"

Mrs. Ambu: "Succinylcholine"

Dr. Grumpy: "What happened when they gave you succinylcholine?"

Mrs. Ambu: "I stopped breathing."

Monday, February 4, 2019

Snow

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

Mr. Flurry: "Hi, I have an appointment later this morning, but am trapped at home by all the snow."

Mary: "I understand, we can certainly reschedule it for later this week, or next. What times of day work best for you?"

Mr. Flurry: "No, I'd really like to make this appointment. Isn't there some special doctor's line you can call or something, where they direct snow plows to my house and clear a route so I can get to the appointment?"

Mary: "No sir, there is no such phone number."

Mr. Flurry: "That's ridiculous. He's a doctor. Doesn't he know the governor, or mayor, or someone who can do that?"

Mary: "No."

Mr. Flurry: "This is stupid. I thought he was a good doctor, but obviously my appointments there have been a waste of time."

Thursday, January 31, 2019

Grammar

Seen in a veterinary orthopedic course brochure:




Thank you, Webhill!

Monday, January 28, 2019

Bagels



I recently was at a hospital staff meeting where one of the administrative clowns got up to speak. He was trying to show us how grateful the hospital is to have all of us, and mentioned that the food in the doctor's lounge costs the hospital $350,000 a year, so we should be thankful.

I know this sort of thing varies between hospitals, but here's what mine supplies to doctors for that $350K:


Morning: bagels and donuts. Boxes of cereal and instant oatmeal. Granola bars. Little milk cartons in the fridge.

Lunch: Tray of deli meats and cheeses in the fridge. Irritatingly small cans of soda. A tray of cookies.

Dinner: Not supplied. Whatever is left over from breakfast and lunch.

Always available: coffee, tea, sliced bread, English muffins, little packets of peanut butter, jelly, butter, and honey.


So, I guess that's what $350,000 a year gets you. I'm sure you also have to figure in there the salary of the person who restocks & cleans it each day, frequent repairs to the heavily-used coffee machine, and a few other items. Plus, they probably fudge in how much money they're losing by not giving us the finger and turning the lounge into another endoscopy suite.


That's not a huge sum of money in the modern healthcare world, but since hearing that figure, I keep wondering how it might be better spent. Maybe a few more nurses in the rotation. Or respiratory techs. Or physical therapists.

I'm sure some doctors would whine, but realistically I think most would be happy with coffee and a bagel in the morning, since that's when most round, and the hospitalists buy their own stuff for lunch anyway.

There are certainly bigger wastes of money in modern healthcare: CEO bonuses (at my hospital his was around $7 million last year) and paying Press-Gainey to do surveys, to name two of them. And the people involved in those things don't care about patients, anyway (regardless of what their PR staff tell you).

But I do care about patients, and would be more than happy to give up a deli tray, cookies, or even a bagel, to improve their care.

That's provided the money actually went to that use. Realistically, it would probably just go to some administrator's year-end bonus for the money he saved by cutting coffee and bagels out of the doctors lounge.

Thursday, January 24, 2019

Survey says

Dr. Grumpy: "So, I last saw you a week ago, when you were in the hospital for Transient Global Amnesia. How have you been doing?"

Mr. Percheron: "Fine, I guess, everything seems back to normal. I've returned to work."

Mrs. Percheron: "He's back to himself."

Dr. Grumpy: "Good."

Mr. Percheron: "I have a question, though."

Dr. Grumpy: "Go ahead."

Mr. Percheron: "What am I supposed to do with the survey the hospital sent me? It has all these questions about my stay, but I don't remember any of it."

Monday, January 21, 2019

Overheard on rounds

Nurse: "Have you had any previous heart issues?"

Patient: "I have a porcelain heart valve."

Nurse: "You mean porcine heart valve?"

Patient: "Whatever."


Saturday, January 19, 2019

And now, music

Thursday, January 17, 2019

Seen in a chart

This isn't the first time I've put up stuff like this, and it won't be the last.

But you know what? Crap like this is no longer the exception. It's the rule. I'd say at least 50%-60% of charts I read from hospitals and practices that use computer charting systems (which is pretty much all of them) have errors of this kind.




And these are what the world is pushing us to use more and more of.

I'm not saying computer chart systems are bad things. They have a lot of advantages. But they also encourage the slacker inherent in all of us. It's easier and faster to check boxes, cut & paste, and use templates than it is to actually type out what's correct. Especially if you skip the critical step of proofreading what you've just done. Most do.

The majority of these errors are just amusing. This one is just stupid, but likely won't cause a serious patient outcome.

But if it can make an error about smoking, it can also make them about your allergies. Your current medications. What conditions you have. Your past surgeries.

And one "minor" error in any of those could lead to a disaster in the right setting.

Monday, January 14, 2019

Cole slaw






I'm in the emergency room, talking to a patient's wife:



Dr. Grumpy: "When did this all start?"

Mrs. Concern: "Last night. He fell down in the bathroom, and said he couldn't move that side."

Dr. Grumpy: "Then what happened?"

Mrs. Concern: "I figured he was just angry at me, and trying to get attention. We'd had this big argument over cole slaw at lunch, because..."

Dr. Grumpy: "Okay, but last night..."

Mrs. Concern: "Oh yeah, anyway, so I watched some TV in bed - there's that new detective show I like - until I fell asleep. When I woke up this morning he was still on the bathroom floor, and boy, was he angry. So that was when I called paramedics."

Tuesday, January 1, 2019

New year's day

 
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