Saturday, April 9, 2011

My readers write

Bruce writes in with today's post. He's a yak herder north of me, in the foothills of Mount Wannahockaloogie. Today, however, he's pretending to be a pediatric lung specialist.

Until recently I thought there were just 4 classes of smokers identified by their answer to the question "Do you smoke?":

1. The righteous nonsmoker who responds, "We do not, and anybody who lights up around my child will be shot on sight"

2. The rabid smoker "Yeah - and so what? Anyone who bugs me about my smoking is shot on sight". This guy always has the most interesting messages on his t-shirts.

3. The drive by smoker comes into clinic smelling like a Carolina tobacco barn. She doesn't smoke herself but her clothing stinks because her (husband, girlfriend, dog, neighbor) smokes. I have been tempted to suggest she take off all her clothing whenever she's around her (husband, girlfriend, dog, neighbor).

4. The nature-loving smoker is the most common type that I encounter. She only smokes outside; never around the kids. All the plants in front of her house are dying.

Recently I met a new variety, who also never smokes around the kids. He told me that "when we smoke we send the kids outside, so they don't breathe it in". I dared not ask what they did when they wanted to smoke while driving.

I also get very interesting responses when I ask if children have allergies. Not long ago I had parents refuse to give their wheezing boy any asthma medication because he was allergic to chemicals, like in medicine, but not allergic to anything organic. I refrained from discussing organic chemistry and that almost all modern medications are organic compounds. There was no future in that conversation.

I did, however, review the results of their son's allergy tests showing reactions to moulds, house dust mites, and the organic family cat. These concerned carbon-based life forms replied that all the results REALLY showed was an allergy to the chemicals used in making the needle used for skin prick testing.

I will retreat now, to my aluminum-clad safe room.

Friday, April 8, 2011

Pop quiz

Okay, it's time for another quiz. Get out your #2 pencils, and let's test your medical knowledge.


You have a history of heart problems, and been having crushing chest pain for the last week whenever you exert yourself, so you:

A. Go to the ER, like your cardiologist told you to.

B. Go to the ER, like your internist told you to.

C. Go to the ER, like your wife told you to.

D. Listen to some guy (who owns a furniture store) that you met at a cocktail party, who told you it's just a pinched nerve and you should go see a neurologist.


If you answered (D), it was a pleasure meeting you yesterday, sir. I'm sorry it was so brief, but if you hadn't run up the stairs to get to my office we likely wouldn't have had to call 911 as soon as you hit the lobby.

Thursday, April 7, 2011

Thursday morning, 7:55 a.m.

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

Miss Shakin: "Hi. This is Cindy Shakin. I only have one dose left of my epilepsy medicine, and my mail order hasn't come yet. Can I get a few days of sample pills from your office until it gets here?"

Dr. Grumpy: "No problem. I'll put some up front with Mary for you. What time will you be in?"

Miss Shakin: "I have to work... Can I send my new boyfriend to pick them up?"

Dr. Grumpy: "Sure. What's his name?"

Miss Shakin: "Hang on..." (thunk as she puts phone down) "Hey! Wake up! Come on! You took all the covers. Hey, what's your name, anyway? No, I don't remember. I was drunk." (pause, comes back to phone). "He says his name is Dave. So a tall guy named Dave, with, um... dark hair, will be by today. Thanks."

"Hey, want some fruit?"

Yesterday afternoon I stopped at Local Grocery to pick up some tomatoes, and noticed this sign in the produce section.

I think the marketing people need a better slogan.


Wednesday, April 6, 2011

Yep

Mr. Kinetic: "Sometimes I'm more shaky, sometimes less."

Dr. Grumpy: "Any triggers? I mean, have you noticed anything that makes you more or less shaky?"

Mr. Kinetic: "Um, well, when I'm less shaky, then I guess I haven't been shaking as much."

Money at work

A few weeks ago Mr. Tachy called my office in a panic. He was at the gym, on one of those machines that monitored his pulse. At one point it said his heart rate was 210.

He panicked, and got off it. He felt like his heart was pounding. He was terrified.

He called my office (NO! I have no idea why he called his neurologist!). Annie sent him to ER. Of course, he didn't go. He drove to his internist instead.

His internist did an EKG, which was fine by that point, and some labs. All fine. So he sent him to a cardiologist.

The cardiologist did all kinds of expensive stuff, and couldn't find anything. So she referred him to a cardiac electrophysiologist. They did more expensive testing of the heart's circuitry, again without any answers.

So after several weeks, 3 doctors, lots of tests, and a crapload of money we knew what he DIDN'T have, but still had no idea why his heart had done that.

Yesterday he came to see me for the first time since this all happened. I asked him if he'd gone back to the gym yet.

"Yeah, I started last week. Guess what? It turned out the machine was broken. It read a pulse of 210 on everything, even when nothing was connected to it."

Tuesday, April 5, 2011

Afternoon interlude

Dr. Pissy: "Ibee, did you see that article a few months ago about diet soda being linked to stroke?"

Dr. Grumpy: "Yeah, several readers sent it to me."

Dr. Pissy: "What do you think?"

Dr. Grumpy: "It's concerning, but I'd have to see more solid data before I believe it. I mean, we've both seen plenty of research, like Saccharin in the 80's, that said it did something awful that later turned out to be incorrect."

Dr. Pissy: "I agree with you, but... I think I'm going to stop drinking Diet Coke. I've been wanting to give it up anyway. I've got a few cases left, but I'm just going to go cold turkey off it."

Long pause.

Dr. Grumpy: "Then can I have yours?"

Annie's desk, April 4, 2011

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

Mr. Goodyear: "Hi, Dr. Grumpy referred me to a cardiologist, and I made an appointment for tomorrow. I'm stuck out of town on business now, and there's no way I'll be able to make it. Can you call them and cancel for me?"

Annie: "Sure. What doctor is your appointment with?"

Mr. Goodyear: "I have no idea. It's on my desk at home. It was someone on the list."

Annie: "What list?"

Mr. Goodyear: "The one from Major Illness Insurance, of cardiologists on the plan."

Annie: "Hang on, let me look it up online... They have 38 cardiologists in our area. Do you have any idea who it may have been?"

Mr. Goodyear: "No. Can you just call all of them for me?"

Monday, April 4, 2011

Party on, dude

Mr. Astalt: "I used to be a heavy drinker, like 1 or 2 full bottles of vodka a day. But I want to be healthy, and don't do that anymore."

Dr. Grumpy: "How much vodka do you drink now?"

Mr. Astalt: "Maybe a quart per day."

Doctors Behaving Badly

Yesterday morning I got dragged from my Sunday sleep-in to see a hospital patient.

As usual, I swung by the doctor's lounge for some morning nourishment, namely a Diet Coke and miscellaneous baked good.

In the tray of muffins, I encountered this:





What is it you ask? Well, let's unwrap it:





Yes, folks, it's a banana-nut muffin that one of my esteemed colleagues gnawed/cut/pulled the top off THEN WRAPPED BACK UP AND RETURNED TO THE TRAY!!!

I decided to just have a bagel.

Saturday, April 2, 2011

Back to the artisanal mailbag

Ever since I began whining about the horrific overuse of the word "artisan" and it's derivatives a while back, you guys have been inspired to send in examples.

Due to surprisingly popular demand, I've created a webpage just for this insanity. It's down on the right sidebar, listed with my other specialty page on history stories.

As always, you guys sent in A LOT of stuff. I'm only going to post a few at a time. So if yours isn't up today, don't worry. It likely will be in the future.

And now it's time for (drumroll please):






One of you wrote that you have a free GPS service, which occasionally posts screen ads. And when you drove by an Olive Garden restaurant, you got this:






Artisanal, by definition, means "hand made by a skilled craftsman". As much as I like Costco, somehow I don't think their mass-produced pizza fits that category.






Even fast-food giant Wendy's is doing it. They also get bonus points for putting another overused annoyance, "panini" onto the same menu page.






With your artisanal breakfast you'll want coffee...





Some of you, however, may prefer to stay home and prepare meals with artisanal kitchen appliances (in great colors, too!)




But don't eat TOO much or you won't fit into your swimsuit!






And if all this artisanal crap makes you want to vomit, maybe it's time to head for the toilet.


Saturday re-runs

Due to yet more Scouting activities today, I'm re-posting a touching ICU moment.


This morning I was called to evaluate a 23 year-old lady who was found
floating face down in her pool. Probable suicide attempt.

While I was writing my chart note a nurse came over to tell me that the
patient's fiancé was on the phone, and wanted to talk to a doctor about
what was going on. I picked up the phone and had the following
conversation:

Dr. Grumpy: "Hello?."

Mr. Fiancé: "Yeah, are you the doctor taking care of my fiancé, Jane Doe?"

Dr. Grumpy: "Yes sir."

Mr. Fiancé: "Are her car keys there? 'Cause it's my car, and I need it back."

Dr. Grumpy: (astounded) "No sir, there aren't any car keys here."

Mr. Fiancé: "Well, did she leave a note saying where the car keys were, or where she left my car parked? I need it, because I have stuff to do today."

Dr. Grumpy: "No, sir, nothing like that"

Mr. Fiancé: "Well, you're no help to me" (hangs up).

Friday, April 1, 2011

One of the best for today. EVER.

Online entertainment

Last night I was signed up to do CME (continuing medical education) with a live webcast.

I don't do these very often, but it was free, I needed the credits, and I figured I could do some paperwork while tuned in. Who knows? I might even learn something.

So the talk began. The speaker was broadcasting from his home office, using a webcam on top of the computer. It seemed like the usual monotonous stuff... "When considering options in the treatment of Frickle-Martin syndrome one must first..."

Then his cell phone rang. "Oh, sorry everyone, I'm on call for my group tonight. I had to switch and tonight was the only... Hello? Yes, this is he. Yes, I rounded on her today. No, the MRI was still being done when I left. I can't talk to her family right now, I'll call back in an hour."

A few minutes later he was reviewing a nail-biting slide on cellular metabolism when he suddenly jumped back in his chair and a large, furry, white Samoyed reared up next to the desk, put it's paws on it, and stared straight into the camera "No! Down Sweater! Bad dog!" Not to be turned away, Sweater licked the speaker's face before disappearing.

A few more minutes went by, when there was a voice in the background. I couldn't hear what it said, but the speaker immediately turned away from a heart-pounding genetics slide and yelled: "I'm busy! I'll look at the math homework later."

Another few slides passed, and a phone rang. He ignored it for 3 rings then answered: "Hello? No, she, went to get Laura from piano class. I'll tell her you called."

The rest of the talk, unfortunately, was uneventful. I finished some office dictations, and made a mental note that if I'm ever asked to a talk like that (nobody is calling, either) I'll probably do it from my office downtown.
 
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