Sunday, January 24, 2010

Sunday Morning, 4:05 a.m.

Bleary-eyed, I stumble into the doctor's lounge. I'm on call. I have a migraine, though the medication is starting to take effect. I'm sleep deprived. I forgot to grab a Diet Coke on the way out of the house. I need caffeine, calories, and fluids.

It's been picked clean. No bagels, bread, or muffins. Shelves empty. Refrigerator empty. Coffee machine broken and overflowing into the sink.

After a careful search I found:

3 packets of melba toast.

1 packet of fat-free, calorie-free, taste-free cream cheese.

And an 8 oz. can of caffeine-free diet RC cola that was lying between the refrigerator and the sink. It was covered with dust bunnies and warm from the fridge motor. The hospital hasn't carried RC in years.

This sucks.

Saturday, January 23, 2010

On Call, Again. Live the Adventure

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

Mr. Cabbage: "Yeah, I see Dr. Nerve for my back problems, but for the last 2 hours I've had this heavy chest pain, too."

Dr. Grumpy: "Sir, you need to go to ER for that. NOW!"

Mr. Cabbage: "I don't want to. Can't you give me a pain pill or something?"

Dr. Grumpy: "NO! I'm a neurologist, sir. And chest pain is scary. You need to get it checked out ASAP. Do you have a cardiologist?"

Mr. Cabbage: "Yeah, but I already called him. He told me to go to ER, too."

Dr. Grumpy: "Then why are you calling me?"

Mr. Cabbage: "I hate going to ER, so I thought I'd call some of my other docs for ideas.

Dr. Grumpy: "You need to go to ER."

Mr. Cabbage: "My internist said that, too."

Dr. Grumpy: "Look. This could be serious. If you don't go, that's your business. But ER is the best advice I can give you."

Mr. Cabbage: "You're no help at all. I'll call some of my other docs. Thanks for wasting my time."

(click)

Things that make me grumpy

This morning I went to the hospital to round. As I was walking in, I ran into Dr. Prik, who'd parked in a handicapped space near the hospital entrance. He had a handicapped placard hanging from his rear view mirror.

He looked fine, but being a neurologist I know that many people who legitimately need handicapped spaces can look fine at first glance.

Dr. Grumpy: "You doing okay?"

Dr. Prik: "Yeah, fine. How about you?"

Dr. Grumpy: "Oh, I just saw the handicapped thing."

Dr. Prik: "Yeah. That was from when my wife broke her ankle a few years ago."

Dr. Grumpy: "I remember that."

Dr. Prik: "She's fine now. I just hold onto it. I hate having to walk too far to the building when I'm on call."


So, Dr. Prik, you hereby win the "Golden Asshole Physician Award" for your jackass sense of entitlement, and for your contributions to making the rest of us look like scum.

Also, you win the "Phailed Physically Phit" award for showing another reason as to why people are fat. Because YOU'D rather not burn a few extra calories, and at the same time ensure that someone who needs a decent space won't get one.

Friday, January 22, 2010

Mary's Desk, January 22, 2010

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

Mr. Pancake: "Hi! This is Bill Pancake. I have an appointment with Dr. Grumpy this afternoon."

Mary: "Um, yes, at 2:15."

Mr. Pancake: "Well, I'm right across the street having breakfast, so I want to come in now."

Mary: "Let me see... I'm sorry, we're completely swamped this morning, and can't do that."

Mr. Pancake: "Well you're not very accomodating."

Mary: "I'm sorry, it's just very busy today. Normally we would."

Mr. Pancake: "That's rude! I'm already here! I don't want to have to go all the way back home."

Mary: "I thought you lived in the apartment building across the street, within walking distance?"

Mr. Pancake: "What does that have to do with it?"

Bwahahahahahaha!

The rivalry between doctorhood's medical and surgical branches goes back to Hippocrates, and has led to some friendly (and not-so-friendly) ribbing over time.


There's a surgeon upstairs in my building, who I've treated for migraines for a few years. Yesterday he had a severe headache, which was different from his usual ones. I was worried something bad had happened, so I admitted him to the hospital, and ordered a bunch of tests.

At around 9:00 last night I got paged by the radiologist with the MRI results.

Dr. Grumpy: "What have you got?"

Dr. Radar: "I'm looking at Dr. Surgeon's head MRI. It's very abnormal."

Dr. Grumpy: "Crap. What's up?"

Dr. Radar: "He has a large intracranial soft tissue mass, which is almost never seen in surgeons."


I was laughing so hard I had to get off the phone (the study was fine, folks).

Thursday, January 21, 2010

More hairs fall out

Dr. Grumpy: "What can I do for you?"

Mr. Tremor: "My hands shake."

Dr. Grumpy: "How long has this been going on?"

Mr. Tremor: "Since they started shaking."

Skool Nerse Time

This is Mrs. Grumpy.

I'm sorry so many of you kids out there suffered injuries during the Martin Luther King holiday, and have required repeated trips to my office since then. I'm sure Reverend King would be flattered to know that you understand his life as "he was that guy who did something and then got killed."

Anyway, since your impression of MLK day (or Veteran's Day, or President's Day, or Columbus Day) is that it was created solely for you to spend it lying on the couch, eating Fruit Loops, and watching Nick, it's amazing to me how many of you suffered sprains. Apparently getting off the couch is trickier than it looks.

So I wanted to publish this guide for your future reference.

1. If you come to the school nurse about a serious injury of some sort to your writing hand or thumbs, DO NOT come in and write me out a detailed note on how you can't use your writing hand. Also, claiming you can't use your thumbs, and then texting your bff while sitting there, doesn't score points (And I get to confiscate your phone, since it's not supposed to be on during school).

2. If you come in more than once for a limb sprain, please try to remember where it was the first time you came in. Switching joints and limbs doesn't give you a lot of credibility. And asking "which one was hurting me last time?" is only going to get you sent back to class.

3. I know when the math quizzes are. Don't think I don't. Your teachers and I do talk.

4. Stop asking for ACE wraps (I know your parents want them). The school hasn't been able to afford them since 1995. Here is what I have: Band-aids and Kleenex. If you're looking for someone to make a miracle cast out of popsicle sticks, duct tape, and Jell-O you can either watch MacGyver or call a Boy Scout.

5. Walking around with a mouthful of hot chocolate to raise your temperature isn't going to get you anywhere. A temperature of > 110° F (43° C) is generally not compatible with life, let alone playing your Nintendo while I'm taking it.

Now get back to class.

Wednesday, January 20, 2010

Circus is sounding really good now, too

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

Mrs. Wrinkled: "I don't know. I might. Should I be?"

Mary, I'm running away to join the circus

"Doctor Grumpy, at our last visit you said my wife had Parkinson's disease, and started her on Sinemet for it. And since then her tremor has stopped and her walking is much better. So all her symptoms have gone away on their own. At this point I think you were wrong, and she doesn't really have Parkinson's disease at all."

Maybe you should try Nicorette?

Dr. Grumpy: "Do you smoke?"

Mr. Church: "Yes, but Jesus is helping me quit."

Dr. Grumpy: "How long have you been trying to quit?"

Mr. Church: "7 years."

More Helpful Notes

I sent one of my patients, Mr. Huge, over to a neurosurgeon last week.

Yesterday Mr. Huge returned, so I was wondering what the surgeon thought. I called over and asked them to fax his note. They said they'd get right on it.

5 minutes later, this helpful item showed up on our fax machine. This was all I got. One page.

Except for changing the names, I haven't altered it in any way.

(click to enlarge)

Tuesday, January 19, 2010

Afternoon rounds

Dr. Grumpy: "Does anyone else in your family have a tremor?"

Mr. Pointless: "Nope. But my mom choked to death on fried scallops."

Fun with patients

Mr. Math: "Doc, I'm concerned about my liver on all these pills."

Dr. Grumpy: "What dose are you up to now?"

Mr. Math: "Um, I've got the 25mg pills, and I'm taking 4 of them, twice a day."

Dr. Grumpy: "That's a standard dose, you should be okay."

Mr. Math: "I dunno. I read some scary stuff online about taking so many pills, and I'd like to change."

Dr. Grumpy: "How about if I change you to the 100mg pills, and you take one twice each day?"

Mr. Math: "Oh, that's fine. Thank you for working with me on this."

Sucker!

Dr. Grumpy is always looking for junkies. I try not to deny pain meds to those who need them, but at the same time I hate people who abuse them. They make it harder for those who need them to get them.

Every doctor has been taken by a junkie at some point.

A few years ago one of the ER docs called me. He had an old lady at the hospital, who was visiting from out of town, and had a flare-up of her Trigeminal Neuralgia (a condition with awful facial pain). He asked if I could work her in that day, so I told Mary to put her on the schedule.

She came over from ER. She was very sweet, in her mid-late 70's. Fully dressed in a Salvation Army uniform (even with a little hat with the red badge). She had a long history of Trigeminal Neuralgia, which hadn't bothered her in several months. It was late November, and she was a ranking member of the Salvation Army who'd come to town to help organize the annual holiday bell-ringing campaign.

She gave a good history for Trigeminal Neuralgia. I put in a call to her regular neurologist, but the office was closed for lunch. She'd left her Neurontin and Percocet back home, and needed refills, so I wrote her for some and sent her on her way.

I went on with my afternoon. After about an hour Mary nabbed me between patients. While straightening up the lobby she'd noticed sweet old lady had left the Neurontin script sitting on top of the water cooler. I figured it was an accident, and she'd call looking for it.

Then her "regular neurologist" called. They'd never heard of this patient.

Ten minutes later the ER doc called me. He'd just gotten a call from a police department in another state. They were looking for my patient. She'd stolen a Salvation Army uniform several weeks earlier, and was traveling around, using it to collect as many narcotics as she could. She'd take some, and sell the others, and keep on the move. They'd found she'd filled a script in my city, and were calling local ER's to alert them.

I have no idea whatever happened to her. On one hand, I felt sorry for this old lady who's life was reduced to being a traveling fugitive junkie. On the other hand, I was pissed for having gotten taken, and certainly she was giving the Salvation Army (for all the jokes about bell-ringing, they're a good organization) a bad name.

And, in some strange way, I had to respect her ingenuity and skill as the opponent she was. And laugh at how I'd been beaten by my own view that a sweet little old lady, especially one in a Salvation Army uniform, couldn't possibly be a junkie.


Junkie's and other low-lifes are a common source of amusement on medical blogs. But in reality they're far from funny. For an excellent look at this forgotten, but more realistic side, I recommend this post by my colleague Phathead.
 
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