Think, think... Brain blast!

Okay, it's time for all you armchair neurologists to help me solve a particularly difficult case. The following is, without any changes, the admitting note from Dr. Hospital, who asked for my help on this challenging case:

"88 year old male who woke from a nap with bilateral visual loss. Symptoms resolved when he
opened his eyes. We will admit for stroke work-up, and consult neurology."

Annie's desk, August 4, 2011

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

Ms. Loud: "HI! IS BILL GRUMPY THERE?"

Annie: "No, this is Ibee Grumpy's office. There's no Bill here."

Ms. Loud: "I NEED BILL. CAN YOU AT LEAST SEE IF SOMEONE NAMED BILL GRUMPY WORKS THERE? HE USED TO LIVE IN CHICAGO, IF THAT HELPS."

Annie: "Sorry, there's no Bill here, and Dr. Grumpy isn't from Chicago."

Ms. Loud: "OH NO! OKAY, I'M TRYING TO CALL EVERYONE NAMED GRUMPY THAT I CAN FIND IN THE COUNTRY TO SEE IF HE MAY BE THERE. MAYBE THEY'RE RELATED TO EACH OTHER OR SOMETHING LIKE THAT. I'M HAVING TO USE PHONE BOOKS BECAUSE THE DOG BROKE MY COMPUTER AND WON'T LET ME HAVE IT FIXED."

Annie: "Okay, well good luck, bye."

Ms. Loud: "WAIT! DON'T HANG UP. I NEED TO ASK YOU A FAVOR."

Annie: "What can I do for you?"

Ms. Loud: "IS BILL GRUMPY ALSO A DOCTOR? OR JUST IBEE GRUMPY?"

Annie: "I have no idea about Bill. You're the one looking for him, so you should know."

Ms. Loud: "I DIDN'T THINK SO, BUT IT'S NOT LIKE HE EVER TOLD ME HE WASN'T, SO I'M NOT SURE."

Annie: "Okay, have a nice day..."

Ms. Loud: "HANG ON! IF BILL GRUMPY DOES SHOW UP THERE CAN YOU PLEASE TELL HIM THAT ANGIE LOVES HIM?"

Annie: "Will do. Goodbye."

Things that make me grumpy

There are so many days that I want to put up a sign that says "Control Your Children or Leave".

I have kids. 3 of them. A rambunctious bunch. We generally avoid taking them anywhere like our appointments, and in the rare case where we have no choice we bring distractions: Nintendo DS, books, etc. I know that not everyone has easy access to child care, and understand that.

But...

It's amazing how many people come in thinking my staff and office supplies solely exist to keep their kids busy. Neither Dr. Pissy nor I see anyone under 18, so we don't keep kid stuff around.

I've seen people tell their kids to just go sit up by Mary's desk and play with her. Or give them scissors, crayons, and glue to "make something" out of the lobby magazines. Or ask me if they can play online games on my work computer. Or just let them run amok in my exam room with my stethoscope, hammer, tuning fork, whatever. Ed has been knocked over 3 times in the last year by kids.

I've had patients leave my practice because their kids caused trouble during the appointment, and I've told them they can't return unless they find a sitter. I don't care that it pisses them off. I can't treat you effectively if I'm chasing your child all over because you think it's my job.

In a pediatrics office this is more common, and they are prepared for it. I go to my kids' appointments, and they have all sorts of books and toys to keep them busy (but we still bring Nintendos). But I don't see kids, and don't consider that something I should provide.

Unfortunately, this kind of behavior is common elsewhere. You see kids running wild, knocking stuff off grocery shelves. I know a veterinarian who had a kid, with his parent's permission, urinate on his office floor, and the family thought the vet was being unreasonable to ask them to clean it up. They figured a vet would be used to dogs and cats doing that, so what's the big deal if they let their kid do it?

Although frequently told by patients under these circumstances that "you obviously don't like kids," that's not the issue.

The problem is parents who won't control them.

"Dude! Let's smoke some okra!"

Yes, sometimes you can be desperate. Or not very bright. Or both.

Thank you, Lauren!

Doctor talk

Dr. Grumpy: "Do you take birth control pills?"

Dr. Veterinarian: "No, I've been spayed. Uh, I mean, I had my tubes tied."

But does it treat syphilis?

I'd like to thank a pharmacist, who I suspect wishes to remain anonymous, for sending in this allergy note that a patient handed her.

(click to enlarge)

"You want that plain, glazed, or with sprinkles?" (wink, wink)

When Dunkin Donuts picked "America runs on Dunkin" as their slogan, I bet they didn't think of this lady.

To make it even better, while searching for the story, I discovered this review of that DD franchise:

(click to enlarge)

Great moments on rounds

I had a hospital consult on a pregnant lady with migraines. I recognized the name as being one of my drug reps.

The door was closed, so I knocked, and someone yelled for me to come in.

I went in. "Hi, it's Dr. Grumpy, they asked me to..."

I stopped.

She was having a trans-vaginal ultrasound, her legs up and apart in the stirrups. The ultrasound tech had the probe up in her...

I was embarrassed, and began to retreat. "I'm very sorry, I'll come back this afternoon..."

She said "You might as well stay. I'm being transferred to a new territory, anyway."

Sunday afternoon

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

Mike: "Hi, this is Mike Hormone. You saw my girlfriend a few weeks ago for a left arm injury? She had a lot of trouble using her arm? I was with her at the appointment?"

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

Mike: "Well, she's getting a lot better, like you said she would and, um, I..."

Dr. Grumpy: "Yes?"

Mike: "Is there anything that might, like slow down her recovery? Not a lot, 'cause she's my girlfriend and all, but maybe just make it take longer?"

Dr. Grumpy: "Um, we're trying to get her better."

Mike: "Yeah, but she can use the arm for almost everything now, and when it was really weak she had me come in the shower to shampoo her hair for her, and that sort of got things going if you know what I mean..."

Weekend reruns

English is an odd language. Being a native speaker, it seems pretty easy to me. But I'm generally lousy at other languages. I took 2 years of Spanish in high school and 4 in college, and I still can't speak it worth crap.

As you guys know, I moonlight doing medical market research interviews. Some are over the internet, some are in person, and some are by phone.

Some of the phone meetings have been outsourced overseas, so occasionally I find myself chatting with someone who speaks English, but with a non-American accent. Occasionally it's someone to whom English is a second language, though usually they're still quite good at it. And that's the situation I found myself in yesterday morning.

The study was on my interactions with drug reps, given by a lady with a mild, nonspecific, accent, but her English was still quite good and understandable. Unfortunately, it was also very old-style, and oddly formal, with phrases and words that aren't used much among modern English speakers. Understandable words, just a little odd.

Most of them were minor, but one was an issue. She used the old word for personal interaction.

Which is "intercourse".

Yes, I know it can mean ANY kind of personal interaction, and the technical phrase for sex is "sexual intercourse". But it's been shortened over time, to where now intercourse just means you're doing the wild thing.

And I'm a veteran of crazy patients, and having to keep a straight face. And I freaking lost it here, (thank heavens for the phone mute button) and at one point had to run to the john to keep from peeing myself (I told her I was going for a Diet Coke).

Here are some of the questions:



"How many times a day do you have intercourse with drug reps?"

My inner voice: It's variable, depending on the time left after I have intercourse with patients.



"If a drug rep provides lunch for your office, are you more likely to have intercourse with them?"

My inner voice: My standards aren't that high. If she's hot, I don't care if she brings prime rib or Taco Bell.



"Do any of your staff members also have intercourse with drug reps?"

My inner voice: Oh yeah, we have a non-stop orgy here. Nowadays I just wear a silk robe to work.



"During intercourse, did the rep provide you with insurance formulary information?"

My inner voice: If she did, I was too preoccupied to notice.



"Following intercourse, did the rep provide you with medication samples?"

My inner voice: No, but we shared a cigarette.



Wait until Mary and Annie find out I had intercourse with a marketing person yesterday. Of course, then I'll be having intercourse with them, too.

Overheard at home

Marie: "See? Here's a picture. I told you it looked like this."

Craig: "Well figgle my newtons!"

Marie: "What does that mean?"

Craig: "I don't know."

Bad ways to meet girls

Whatever happened to the good old "What's your sign?" or "Do you come here often?"

Apparently this guy needed to try his own method.

Then why did you come here?

Mrs. Tech: "The headache is over the entire right side of my head, I get horrible nausea, and I can't stand light or noise."

Dr. Grumpy: "That's a migraine."

Mrs. Tech: "No, it's absolutely NOT a migraine! You should know better!"

Dr. Grumpy: "Why are you so sure it's not a migraine?"

Mrs. Tech: "The iPhone app says so."

Driver's Ed

Dr. Grumpy: "Anything else I can do for you?"

Mr. Bozo: "Yes, I need you to write a letter to the state, to get my 13 year old son a driver's license."

Dr. Grumpy: "The state driving age is 16, and your son isn't my patient."

Mr. Bozo: "I know, but you're treating my back pain, and when it really hurts I'm not comfortable driving. My son is the only one who's available."

Dr. Grumpy: "But he's not old enough to drive."

Mr. Bozo: "He drives those motor cart things all the time at the fun park. He does fine. Can't you just send the state a letter to get him a license?"

Dr. Grumpy: "I can't do that."

Mr. Bozo: "Why can't you be reasonable?"