Welcome to Grand Rounds, year 7!

As you're all aware, I was asked to host online Grand Rounds this week. So thank you all for coming! I'll be returning to my regularly scheduled whining tomorrow.

Coffee and bagels are in back. Sign in on the sheet. Medical students, please remember that you're allowed to sit ONLY if there are chairs left after the attendings, fellows, residents, and homeless people (here for the bagels) have been seated.

Food was provided by our drug rep Rikki, on behalf of Wirfliss Pharmaceuticals. She asks that when writing a prescription, please keep their many Wirfliss products in mind.

Before beginning, I'd like to thank Dr. Fizzy for her suggestions on doing grand rounds, and (as always) her totally awesome collection of medical cartoons. If you don't already read her, then (after this) click here and get started.

A big thank you to everyone who sent stuff in. I received A LOT of submissions, and unfortunately couldn't use them all. So if you didn't make it, I'm sorry. Everything I got was good. Some of you sent great anecdotes and stories, but in keeping with tradition, I limited it to links for blogs.

And we're off! The topic was: THINGS THAT MAKE ME GRUMPY!


To start, I present: THE PHARMACISTS!




The king of pissed-off pharmacists, The Angry Pharmacist, submitted this post about an issue that drives him (and many docs) nuts- the prevalence of meds ending in -XR, -XL, -CR, etc.

My esteemed colleague Pharmacy Chick sent her list of pet peeves from the other side of counter. And I have to agree with her.

Next up in the center ring: THE NURSES!





From the Florida keys, we have Mojito Girl. She brings us stories from the ER "spa" there. Mojito, dear, although your email promised "truckloads of money sent to a Swiss bank account" for putting this up, I still haven't received it. Perhaps this is because I don't have a Swiss account. Or simply the logistics of you driving trucks from Florida to Switzerland.

Nurse Running Princess (like many of us) finds herself stymied by some of the asinine ideas that drift down from hospital management.


Here they are: THE MEDICAL RECEPTIONISTS!





My idol, Dr. Oscar London, once wrote that "The doctor is your humble servant. The secretary is Her Majesty, the Queen", and I quite agree. You all know my boss secretary, Queen Mary, but she's far from alone in the combat of front desk medicine.

Queen Kate sent 4 totally awesome examples of the insanity that goes on in the trenches, and I couldn't pick one over the others (I tried). So here, in no particular order, they are:

Crayzee 1, Crayzee 2, Crayzee 3, and Crayzee 4.

I think if Mary and Kate start a blog together, they'll drive me off the web.


Next up: THE PARAMEDICS!





Medic999 had a lot to say about the insanity of an answering service that doesn't quite grasp what "the patient is dead!" means.


Now taking the stage: THE DOCTORS!





Dr. Orion, from the wild world of psychiatry, writes about misadventures on a book tour.

On the topic of false advertising, pathologist Gizabeth writes in about being promised a lab specimen of gangrenous hemorrhoids (doesn't that sound horrible?), and her disappointment when they weren't.

Doctor D gets peeved over patients who want a doctor to have superpowers to diagnose and treat without ever seeing them.

Jill-of-all-Trades, M.D. wanted to stress ways to avoid being grumpy (no, I don't understand that, either), and sent in tips to properly conduct the circus of medical practice.

Master Surgeon RLBates wrote in concerning a trend that makes her (and me, too) grumpy: A TV show that's promoting plastic surgery as a prize package for brides!

Manixter, an anesthesiologist who specializes in passing gas, writes in to tell us what it's like when you have to use bedside manner with a relative. She also had a Jeff Foxworthyesque piece on you may be an anesthesiologist if...

Dr. Kirsch, while not necessarily grumpy, sent in a poignant post on faith and medicine.

Glass Hospital sent in his secrets about working at a university student health center.

Dr. Dalai, a radiologist who specializes in the "I'm tearing my hairs out by the roots" field of IT, sends in his grumpiness over trying to set up a PACS system.


Entering the spotlight: THE RESIDENTS!





MD Resident, who's surviving the hazing ritual of call, wrote about annoying aspects of residency.


And now... THE MEDICAL STUDENTS!





Action Potential wanted to gripe about schools promoting "new curriculum" ideas that do nothing but make you look socially inept.

Mack wanted to grump about the serious medical condition Facebookalgia.


And last, but certainly not least,... THE PATIENTS!





The Banshee, who recently had a baby without any freakin' pain meds, sent in this story of a whiny family member.

Pink Tee Shirt sent in her peeves from the patient side of the medical world.

Copewithpain wanted to discuss problems encountered at the doctor's office.

Joseph Morris wanted to discuss disgusting things about public bathrooms.

While I, personally, revel in my grumpiness, the folks over at Bedside Manner wanted to suggest ways to avoid being Grumpy. Here are their suggestions, though they forgot to list "don't run out of Diet Coke."





It looks like we're running out of both time and bagels, so I'll wrap up. In closing, I'm going to post my own pick, something entirely unrelated, and one of the best pieces of blog writing EVER. Nurse Maha's awesome take on Edgar Allan Poe's classic poem, The Raven.

And that's all! Thanks for joining us for Grand Rounds. Let's have a round of applause for Nick Genes (no relation to Splice) and Val Jones for asking me to do this (I'm still waiting for my Diet Coke, by the way). Next week Grand Rounds will be held over at Sharp Brains, so tune in then.

Medical students, please don't put the leftover bagels in your white coats until the residents have picked them over.

Homework

Tonight Marie asked me to look over her math homework. It featured this:

Question: "Write a word subtraction problem using the numbers 18 and 10."

Under it Marie had written: "Frank had 18 words and gave 10 of them to Craig. Frank had 8 words left."

More Medical Research

I'd like to thank my reader PMH for submitting this.

I think we've all played beer pong. I mean, what would college be without it?

And most of us, especially shitty players like me, can attest that you can get pretty damn drunk playing it. Definitely more so than other drinking activities, such as watching football or flying a commercial plane.

So you can ask pretty much any college student "Hey! Do you get really drunk when playing beer pong?" And the answer will be "Yes!".

Of course, walking around a college campus and asking such questions, or simply hanging out in a bar and taking notes, are way too simple for your average researcher. So instead the folks at one university had to create a simulated model of beer pong using computer software. Really.

What did they learn?

That playing beer pong leads to increased alcohol consumption. Shocker, huh?

Here's the article.

September 27, 1854

After the war of 1812 , the United States and Great Britain resumed commercial trade.

On both sides of the Atlantic, businessmen competed for their share of this increasingly lucrative business. Faster ships made more money, even if it meant going full speed into bad weather and poor visibility. Many ships vanished, forever listed as overdue, and presumed lost to bad weather and icebergs.

On the Eastern side, the driving force was Samuel Cunard. In the 1840's he came to dominate the Atlantic market, with the line that to this day bears his name. The British government backed him financially, so the ships could, in the event of conflict, be requisitioned by the navy (which they often were).

On the Western side, a number of American lines tried, with varying degrees of success. The U.S. government was less inclined to become involved in these matters, and so capital was harder to raise for building ships.

As sail gave way to steam, this changed. The Americans were concerned that Cunard's steamers could be converted to warships. Faced with both real economic and feared military competition, the government began backing various companies to try and win trade back from Cunard.

The man to lead this was Edward Collins. With government subsidies he built 4 large steamships (Arctic, Pacific, Baltic, and Atlantic), bigger, faster, and more luxurious than Cunard's ships, to challenge his rival. The plan was to run a tight schedule across the Atlantic.

The Collins Line ships, with their combination of sails and paddle wheels, were some of the fastest in the world at the time. They showed the Atlantic could be crossed in the remarkable time of 10 days, and in a few cases, 9.

Backed by their respective governments, Collins' and Cunard's lines competed intensely to dominate the 3000 miles of north Atlantic. Until 12:15 p.m. on this day.

As the Arctic steamed west, through a heavy Newfoundland fog, she collided with a small French ship, the S.S. Vesta. The Vesta, although much smaller, had a hull reinforced with iron.

In the first few minutes after the collision, many of the Vesta's crew assumed their damage was fatal, and abandoned ship (against orders) to try and reach the larger Arctic. They were wrong. The crew of the Vesta worked miracles and overcame the damage.

Captain James Luce of the Arctic was a veteran of the sea. Believing his own damage to be minimal, he turned the Arctic around to aid the Vesta, and launched 2 lifeboats to help evacuate it's passengers to the Arctic.

These orders were quickly canceled when one of the lifeboats reported the severity of the damage to him. The ship was badly damaged. Like the Titanic 58 years later, he had the legally required number of lifeboats. And they weren't nearly enough to hold everyone on board.

Cape Race was 4 hours away. With his duty to his own ship clear, Luce abandoned the Vesta, heading for land. His hope was to beach the ship before she could sink.

The wreck of the Arctic over the next few hours quickly turned into a nightmarish struggle for survival, very different from the civility seen in the Titanic. Captain Luce accepted that he and his 11 year old son (who was traveling with him) were going to die, and did his best to save passengers. He was betrayed by his crew and most of his officers.

His crew disobeyed orders, commandeered the lifeboats, and fled. A trusted officer and handpicked team of seamen were placed in a lifeboat so that passengers could be lowered down to them. As soon as they reached the water they rowed away, with plenty of space in their boat.

Without lifeboats, Luce and his few remaining crew did their best. They tore the wooden deck to pieces, frantically trying to build rafts. Doors were torn from hinges to be used for flotation. All furniture made of wood was assembled on deck in hopes of saving more lives.

Of 408 who sailed, there were 86 survivors (64 crew, and 22 passengers). Not a single woman or child lived. They're remembered by a monument in Brooklyn's Green-Wood Cemetery.

Captain Luce, surprisingly, survived. He and his son went down with the ship, but were ejected from the vortex as it sank. As they swam away, a large wooden paddle wheel cover broke loose from below the sea. It launched into the air like a rocket, then came down, killing his son. And yet, at the same time, it became a makeshift lifeboat for Luce and a handful of swimmers. They were picked up after a few days by a passing ship.

The loss was a disaster, both personally and financially, for the Collins Line. Besides Luce's son, the deaths included Collins' wife and 2 of their children.

Although mostly forgotten today, the disaster dominated headlines on both sides of the Atlantic for a month, until replaced by the Crimean War. It had the same effect then as the Titanic would in 1912. Safety specialists recommended specific East-West shipping lanes. Slower speeds and loud whistles in fog. Lifeboats for everyone. The majority of the recommendations were ignored until the aftermath of the Titanic.

2 years later, in 1856, the Arctic's sister, the S.S. Pacific, vanished en route from Liverpool to New York.

It was another blow for the Collins line. There was an economic recession, and the U.S. government was now willing to let Cunard have the Atlantic. Collins' subsidies were cut, and in 1858 his line folded. The surviving ships were auctioned off.

The wreck of the Arctic hasn't been found (to my knowledge no one has looked).

The Pacific was thought to have been lost to storms or icebergs in the north Atlantic. To the surprise of everyone, she was accidentally found in 1991 in the Irish Sea, only 60 miles from where she left Liverpool. Why she sank remains a mystery.

Cunard survives to this day, though is now owned by Carnival Lines.

Government subsidies for shipping, with the ships to be used in time of war, continued into this century in all the major powers.

The last American attempt to share the Atlantic trade lies, mostly forgotten, in Philadelphia. She is the liner S.S. United States, built with subsidies after World War II. The government paid for her huge size and (even to this day) remarkable speed, with the plan of using her as a fast troop transport in future conflicts. Her commercial career, like all liners, was doomed by the passenger jet. Multiple attempts continue to be made today to save her from the scrapyard.

Attention crooks!

Look, if you're trying to smuggle cocaine on an airplane, you take your chances. I think all of us have had our luggage lost at some point. So I suppose a bag with illegal drugs is as likely to go missing as one with my dirty laundry.

BUT, in the event that happens, you should probably take it as a loss. It is NOT going to help you to file a "lost luggage claim" on your case of contraband.

Like these guys.

I'd like to thank my reader Kayden for submitting this.

No means no

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

Mr. McPayne: "Yeah, are you covering for Dr. Cortex this weekend?"

Dr. Grumpy: "Yes."

Mr. McPayne: "Okay, I need more Vicodin for my pain."

Dr. Grumpy: "What kind of pain are you having, sir?"

Mr. McPayne: "You know, stuff that hurts. I need Vicodin for it. I get it from Dr. Cortex."

Dr. Grumpy: "Is this a new problem?"

Mr. McPayne: "Nope. If I can get some Vicodin I'll be fine."

Dr. Grumpy: "I can't call in narcotics for other doctor's patients on the weekend."

Mr. McPayne: "Why not? It sounds like your phone is working?"

Dr. Grumpy: "I don't know your case at all. You can call on Monday when Dr. Cortex will be back, or go to an ER if you feel this is urgent."

Mr. McPayne: "I ain't going to ER. I just want some Vicodin. Can I come to your office today so you can see me, and I can prove I have pain?"

Dr. Grumpy: "No, sir. My office is closed on Sundays."

Mr. McPayne: "Then can we meet at a McDonald's or something?"

Dr. Grumpy: "Goodbye." (click)

Sunday morning, 2:25 a.m.

"Hi! I'm a patient of yours and I'm 8 months pregnant and my water broke and I've started having regular contractions and I think I need to go to the hospital and can the doctor please call me back ASAP because OH SHIT! I THINK I CALLED THE WRONG DOCTOR PLEASE IGNORE THIS MESSAGE!"

(click)

I still can't stand it.

This is a repeat of a post I ran last September. And since the same issue STILL drives me nuts, I'm putting it up again.


Dear Mr. President,

I don't want this to be a political blog. There are plenty of other sites for that. But we now face a national crisis of such serious proportions that it dwarfs other issues, such as global warming, health care, and middle-east peace. It now threatens the very fabric of our society, and directly affects every citizen. And I can remain silent no longer.

It's still September, and every store near me ALREADY HAS THEIR CHRISTMAS DECORATIONS UP!

I have nothing against the holidays, Mr. President. Peace on Earth and all that stuff. But moving them up as if they were being held in another time-zone or alternate universe is getting out-of-hand. As far as I know, Christmas hasn't budged in my lifetime. And treating every day like it was Christmas (like the stores seem to want me to do) is not helping.

The well-respected Nick documentary program, The Fairly Oddparents, has carefully researched what would happen if Christmas were held every day (Episode 107, air date 12-12-01 I have kids, OKAY!). Their conclusion? It would be catastrophic.

There also seems to be a degree of unintentional discrimination. For example, Hanukkah starts more than 3 weeks before Christmas this year, but I didn't see Hanukkah decorations going up 3 weeks before the Christmas ones. In fact, I haven't seen any at all yet. Or Kwanzaa stuff. Or Festivus. Or New Year's.

This seasonal perversion extends to other holidays, too. I mean, by January 2nd most stores are decked out with Easter junk, and on July 5th the Halloween crap is up.

So, Mr. President, I propose the following, federally mandated solutions (please note: I'm only including those holidays that retailers love. Let's face it, not many of us are out there buying gifts for Groundhog day or cards for Columbus day. I'm also leaving out local holidays like Delaware Statehood Day, the Montana Huckleberry Harvest Celebration, and the Byron, Illinois, Turkey Testicle Festival).

Valentine's Day Decorations will NOT be put up until the 3rd week of January.

St. Patrick's Day Decorations will NOT be put up until after March 1st.

Passover/Easter decorations will NOT be put up until after St. Patrick's day.

Independance day decorations (July 4th) will NOT be put up until the 3rd week of June.

Halloween stuff will NOT be put up before October 1st

Thanksgiving Stuff will NOT be put up before November 1st.

Christmas/New Year/Hanukkah/Kwanzaa/Festivus stuff will NOT be put up until the day after Thanksgiving.

(Please note: there should be some flexibility here, as Hanukkah and Easter/Passover may vary, but decorations should NOT be hung more then 3 weeks prior to holiday onset).


An alternative plan would be to have a single annual holiday combining all of the above, called St. Christmukahpasseastkwanpatfourthnewfestgivingween. Decorations for the combined holidays may be hung for 30 days prior to this event, and MUST be removed the day after.


Punishment for business owners who violate these laws would be on a 3-step basis:

1st offense: Business license revoked for one month.

2nd offense: Tarred, feathered, and forced to eat fruitcake.

3rd offense: Drawn and quartered, then served with fava beans and a nice chianti.


Yours truly,

Ibee Grumpy, M.D.

Tough case

I'm reading a hospital discharge summary, and discovered this quote from a neurosurgery resident:


"The patient was given Valium 10mg and Haldol 10mg. He then become lethargic, with decreasing oxygen saturations. The cause of his sudden lethargy was unclear. A head CT was unremarkable, and a STAT neurology consult was called."

Doctors for Gooder English

Doing an online survey this afternoon, and encountered this question.

Gosh, I wonder what happened?

Yesterday afternoon I went to the hospital's EEG reading room to look at the day's studies.

Unfortunately, only one had gotten done all day, and there was a note on the monitor that said "Doctors, sorry we couldn't do all the studies today. We had to send the EEG machine to Bio-Med to have it thoroughly cleaned".

Lucky for me, it was one of my studies that did get done. It was on a confused ICU patient, so I started reading it.

The study ended abruptly at 8 minutes (normally they go for 20), with the following commentary in the tech notes:

0745: Pt yawning.
0748: Pt moving around, agitated.
0750: Pt pulled poop tube out of butt and is playing with it. Nurse running to bedside.
0751: Ending study.

Mary's Desk, September 22, 2010

(Lady comes in, signs in, then continues to stand at counter)

Mary: "Hi, Mrs. Patty. We'll get you back in a sec. Do you need something?"

Mrs. Patty: "Um, yeah, do you guys have a hamburger I can have?"

Mary: "Excuse me?"

Mrs. Patty: "Do you have a hamburger? I just dropped my mom off at the airport, and I'm really hungry."

There's a lot of that going around

For the original post on this topic, click here.


Dr. Grumpy: "Did you have an X-ray for the neck pain?"

Mrs. Daypro: "Yes. A friend said the carpal tunnel there is causing my neck problems."

Now THAT'S ambitious!

I'd like to thank my reader Miriam for submitting this. She noticed it in a hospital patient's (admitted for a knee problem) paperwork .

(click to enlarge)