Saturday, December 31, 2011

Not right...

Before I start this story, the answer is 'yes,' the story is true.  It sounds like something someone would make up as a story as to why the system is broken, but it's not.

Case Manager:  "Yes, sir, did you want to talk with me?"

Patient:  "I just wanted to complain about something."

Case Manager:  "Okaayy..."

Patient:  "Before I moved here (to our state), I looked up online which states get the largest proportion of federal funding for welfare and Medicaid.  I am very disappointed so far in the amount of assistance I have received."

Case Manager:  "Well, we are a very poor state, statistically.  What assistance were you applying for?"

Patient:  "I have a place to live and my application for federal housing was turned down because of that.  I was denied welfare because I haven't had a job in several years and couldn't prove my income qualified."

Case Manager: "Well, I won't be able to help you with any of that."

Patient:  "Well, I need you to get all my medicines for free.  I need you to call all the manufacturers of the medicines they are putting me on and get them to give them to me for free.  I also need you to write off this visit to the hospital so I don't have to pay for anything."

Case Manager:  "Sir, I cannot do that."

Patient (continuing):  "I need you to call Medicaid and tell them that I qualify."

Case Manager:  "Well, I can help you with the application..."
Patient:  "I really want to tell you how disappointed I am about not being on welfare by now.  It's not right that I have to wait like this."

Ok, I left a lot of this conversation out because there is a lot of backstory I won't go into, but the gist of it is this:  a HEALTHY 40 year-old man left his home state and came to ours SPECIFICALLY to live off the government for the rest of his life.  He had worked manual labor for most of his life, had zero disabilities and was upset that this kept him from getting all the free money he wanted.  He had not worked in several years because he didn't feel like it, not because of a shortage of manual labor jobs out there (he said this).

These people, while a very small minority, actually freaking exist.  The only redeeming part of the story is that the federal aid office saw through his B.S. and refused him most of the aid he claimed he deserved. 

Patient:  "That's not right."

You're right sir, it isn't.  I'm just glad this is the first time I've ever truly encountered someone like this.  We complain about patients who feel entitled all the time, but most of them can be simply laughed off because we know they won't get what they want or if they get it, it's not something that matters.  This guy might not, but if he persists, eventually he'll find a loophole that will allow him to live off other people's efforts and he will do this because he thinks he deserves it by virtue of his birth.  A sad existence, to be sure.


Friday, December 30, 2011

Side-effects may include...

Me: "How did those sleeping pills work out for you?"

Patient: "I didn't take them."

Me: "Why not?"

Patient: "The pharmacist said they cause drowsiness."


Thursday, December 29, 2011


Patient: "why is my infection cute?"

Me: "I'm sorry?"

Patient: "The other doctor, your partner, said I had a cute infection."

Me: *sigh*


Wednesday, December 28, 2011


I had a patient the other day that reminded me of my grandmother so much I figured I'd share it with you.

I had a woman in the hospital who I had admitted several times for falls, this time she had broken her other hip.  I had taken care of her several months back when she had the left hip replaced; this time it was the right one she had injured.  She never complained and always smiled and chatted with me, even though I knew she was in pain.

Shortly after her surgery, I went to her room to round on her.  She was as gracious as ever, smiling politely and holding my hand while I talked to her.  I couldn't help but notice a large tray of homemade chocolate turtles that one of her granddaughters had brought in, tied up with ribbon and plastic in the corner.  They must have kept catching my eye, although I was consciously trying not to acknowledge them.

Me:  "So, we'll be following your labs in the morning and get physical therapy to start working with you..."

Patient (patting my hand):  "Sweetie, do you want a turtle?"

Me (sheepishly):  "Yes, ma'am."

Patient:  "Well you just go over there and get you one out.  I'll tell my granddaughter I ate them, ok?"

Me:  "Yes ma'am, thank you."

As I was about to leave the room after examining her, she made me take another one for later.

Patient:  "Well Dr. Say, I think you're going to make a fine doctor when you grow up one day *wink*"  (See previous post, re:  looking young).


Monday, December 26, 2011

It's QUITTING smoking that's the problem...

Normally I wouldn't go so far as give this guy credence, but I ran across this picture from the people of Wal-Mart site that intrigued me.  The guy who owns this fan has a website called  Going to the website will treat you to such delights as him telling the viewer that it is QUITTING smoking that is the real demon.  He watched his father and mother wither away in their golden years, that's right, because they QUIT smoking, not because they had smoked for 50+ years.  He then goes on to imply in this segment that every person over the age of 100 is a smoker, of course having reached this ripe old age by avoiding stress by smoking.  This diatribe is followed up by a description of how he removed the George Washington picture sign off his van's roof and replaced it with his rather "magnificent eagle collection" (he does not elaborate) and then of course he launches in to what we were all expecting:  the revelation of the REAL enemy here....the pharmaceutical companies.  They, of course, want to see tobacco gone because they can't patent it or make money off of it in any way, shape, or form.  Yes, no one has ever successfully figured out a way to make money off tobacco.  You've discovered their master plan.

Anyway, if you get a moment take a look at the picture of his vans and try not to end up on a militia watchlist by going to his website.


Sunday, December 25, 2011

Merry Christmas!

Welcome to Sunday and, you know, Jesus' birthday and stuff...

Saturday, December 24, 2011

Still ready...

The hospital is very full right now, as can be evidenced by this order:


Friday, December 23, 2011

Both of em'...

Seen in chart:  "Patient has had a bilateral hysterectomy."


Thursday, December 22, 2011

Reasonable request...

Yesterday, 1 p.m.:

Funeral Home:  "Yes, Dr. Say, we're waiting on the death certificate for Mr. Mortis so we can proceed with his cremation."

Me:  "Uh, I haven't seen it in medical records, are you sure you sent it?  Wait, didn't that guy die yesterday?"

Funeral Home:  "Yes, we're needing that death certificate right away.  We have one here that we need you to come by and sign."

Me:  "Well, I guess I could do that if you really need it, where are you guys located."

Funeral Home:  "We're located in Middle-of-Nowhere."

Me:  "That is a two-hour drive from here, I am not driving two hours to sign a piece of paper.  You can fax it to our medical records department and I can send it to you that way."

Funeral Home:  "Uhhhh....fax?"

Me:  "Fax machine. Invented in the 1920's, now almost obsolete, yet we keep using it."

Funeral Home:  "Well, we'll have someone drive it up there so you can sign it.  I can't believe you won't come by to sign this, all of our other doctors do."

Me:  "..." *click*


Wednesday, December 21, 2011

Focus on the important things....

This one is from an ENT friend who saw a patient with me yesterday...

ENT:  "Ok sir, well we're going to get a biopsy of that lymph node to see if that truly is lymphoma that's been giving you all those problems.  After that, we'll get the heme-onc doctor to see you so you can start treatment."

Patient:  "Well, I had a really good bowel movement this morning. I felt really good about that."


Tuesday, December 20, 2011

A.M.A. = you're leaving....

Medical professionals put up with an awful lot of behavior that would not normally be tolerated in polite society.  It's impossible to explain without having experienced it personally, so I'm not going to attempt to describe the frustration that is an integral part of our everyday jobs.  One of the first changes that new initiates to the medical field undergo is the loss of a desire to help everyone, soon replaced with a desire to help those who want our help.  A prime example of this is the A.M.A. form.  This stands for Against Medical Advice and is commonly used to explain the sudden departure of a patient who either demands to leave or demands certain actions (usually unreasonable ones) be taken or they are leaving, to which we will all simultaneously reply, "Well, leave then." 

Patient:  "If you don't give me my Demerol, I'm leaving this place."

Me:  "Well, you're free to leave at any time."

Patient:  "Well maybe I will then."

Me:  "I'll get the paperwork for you."

Patient:  "Wait, aren't you supposed to stop me?  I thought you guys were supposed to do whatever it took to save someone?"

Me:  "No, sir.  You're confusing us with Jesus."


Monday, December 19, 2011


I have a terrible problem with names.  Terrible cannot even describe how bad I am with them.  I can see you every day at work and be unable to produce your name without a name tag in any other situation.  I think it has to do with how much information I have to filter as a doctor every day -- "I don't need to remember his/her name, they are wearing a name piece of information.

When I was in residency, we did a lot of our training with the E.R. residents.  I could never remember their names unless I spent vast amounts of time with them, but again:  name tags.  One of my friends, a 6'5" Irish guy named Lenny came up with the idea of giving all of them nicknames.  We would actually use these nicknames when talking to them and it made it easier.  One night I got a call from the E.R. about an admission that went something like this...

E.R. Doc:  "Hey man, it's McKinney, I got one for you."

Me:  "Who?"

E.R. Doc:  "McKinney, Doctor McKinney."

Me:  "Who?"

E.R. Doc:  *sigh* (voice lowered) "Handsome Dan."

Me:  "Ooohhh.  Hey man, what's up?"


Friday, December 16, 2011

It's a boy...

Constipation is one of our biggest problems in the hospital. Older patients are obsessed with it, many people use it as an excuse to try and stay in the hospital (it's not a valid reason, seriously).

One week, I had an elderly patient who was fixated on his bowels. He'd ask me for something every day, the family would pester the nurses until they'd call me. Finally, I relented and had them give him an enema (complain enough, you get the full Monty, no dicking around with pills) and, to quote the nurses "he had an extremely large bowel movement." When I looked at his daily weights, he had lost 12 pounds overnight. Upon entering his room, he proudly proclaimed, "I gave birth to a mud baby!"


Thursday, December 15, 2011

Down to business...

Having to do this on my iPhone again, so will keep it short.

Patient: "Honey, you know that curtain is pulled because that other lady (her roommate) died?"

Physical therapist: "Yes, ma'am, I heard."

Patient: "Well it didn't bother me any, they just gave me some pills and I slept right through it. Now, let's get on with our therapy."

Thus began the first time I did therapy with a corpse in the room...

Submitted by Melissa.


Wednesday, December 14, 2011

Growing Pains...

The year after I got out of residency I worked in a very small town in Louisiana while my wife finished college. The clinic I worked in was a very poor one and it was constantly booked. This meant patients often waited long periods in their rooms before I got around to them. One afternoon I was glancing at a chart when from the room I heard a baritone voice start singing "Show me that smile agaiiiinnn." It was accompanied with a female "Ooh, show me that smile..."

I waited outside as the couple sang the entire Growing Pains theme song, clearly audible to everyone in the adjacent rooms. When they finished, I walked in and sat down in the chair like nothing happened. They acted like it never happened, either.


Tuesday, December 13, 2011

Comfortable catheter...

Two things: 1. Cell service sucks in NYC; 2. I'm not paying $20 a day to use spotty unsecured hotel wi-fi so I'm posting on my iPhone.

Patient: "This catheter feels weird. It's not comfortable at all."

Nurse: "that's how it's supposed to feel. If you'd like I can take it out and you can get up and go to the bathroom when you want."

*patient looks at bathroom door, three feet away*

Patient: "No, leave it in. I don't feel like getting up."


Monday, December 12, 2011

Heading to the airport for a trip to New York so quick, early-morning post:

Submitted by Jill.

Incidentally, anyone with a story to tell can do so by clicking on the contact/submissions form at the top of the page.  If it's not true, at least make it somewhat believable ;-)

Sunday, December 11, 2011

Saturday, December 10, 2011

Conversation over...

The floor nurses and I have a love/hate relationship, for the most part.  I often tell them that, if I DON'T make fun of them, it probably means I don't like them or just don't know them very well.  I think it keeps them on their toes and it usually keeps me from getting silly phone calls.

Nurse:  "Dr. Say, I was just about to call you.  Your patient in 415 had an elevated blood pressure, but your partner Dr. Kay ordered some clonidine for her so it's taken care of."

Me:  "So....conversation over?"

Nurse (hanging head):  *sigh* "Conversation over."


Friday, December 9, 2011

Make an appointment...

Mr. Can't-Be-Bothered-to-Visit:  "Ok, doctor.  Thank you for the phone update.  I'm going to need you to call me every three to four hours to keep me apprised the situation."

Me:  "No, I'm not going to call you anymore, sir.  I have other patients I am taking care of.  You can see me in the hospital on rounds, if you wish and I'll be happy to discuss his case with you then."

Mr. Can't-Be-Bothered-to-Visit: "I don't have time for that.  This is extremely poor customer service, I have to say."


Thursday, December 8, 2011

Get over it...

Patient:  "I'm scared of dying."

Me:  "Well, I think that's natural."

Patient:  "Yeah, I don't want to go through that again."

Me:  "What?"

Patient:  "Dying.  I've died once before.  Once you die you never get over it."


Wednesday, December 7, 2011


When I was working at the V.A. during medical school, we had a large number of vets come in for detox from drug and alcohol abuse.  The ones that only abused one substance usually weren't too bad, but the ones that came in for multiple substances tended to be a bit scarier.  One benzo/alcohol withdrawal had to be restrained in his bed after he ran screaming down the hall that a gorilla was in his room (we checked his gorilla).  Strange stories from patients when we saw them in the morning were not uncommon and you got used to ignoring strange comments after awhile.

One day, I was seeing a 45 year-old guy who was withdrawing from alcohol and Xanax when he told me he was glad all that was over, because he had a vision that his wife had come in and threatened to kill him during the night.  The rounding team kinda laughed about it at the time, but it wasn't until I said something to the nurses that they told me that she HAD been there and had indeed threatened to kill him.

He was discharged a few days later and agreed to go into a private rehab program at a later date.  He didn't make that appointment, however, as his wife, upon seeing his return, promptly ran him over with her car the following day.  I saw him on the floor the next day with multiple broken bones.  He managed to smile rather glumly and say to me, "I wish the hallucination had been more specific about how she planned to do it."


Tuesday, December 6, 2011

Convenient hypoxia...

Drug Seekers:  we know when you're faking.  No, really.  You might can fool us for a short period of time, but you all make the same mistakes over and over again.  I could even tell you what those mistakes are and you'd still make them. 

One of the most popular diagnoses for a drug-seeking patient to come in with (especially a female) is abdominal pain.  It's vague, it has a large number of diagnostic possibilities and it takes time to work up, giving the drug seeker ample time to load up on all sort of IV narcotic goodness.  One patient I was seeing was a woman in her late 20's whose abdominal pain defied all workup.  Here's another something they don't tell you when we admit you:  if we work you up and can't find anything and the problem is not exceptionally debilitating or life-threatening, you go home.  This woman learned this first-hand when I tried to discharge her.  We already suspected the drug-seeking behavior at this point because the woman would be sleeping whenever you went in to see her, but the moment someone woke her the pain was a 10 out of 10 and she was asking for narcotics.  I wrote the discharge orders and left the floor.  About 30 minutes later, I received a phone call from the woman's nurse, claiming that she had a pulse oximetry reading in the 70's.  I went back up to her room to find the woman's sats 100% on 2 liters of oxygen a minute (very minimal oxygen).  As an experiment, I had the nurse put the pulse ox machine back on her and took the nasal cannula off.  Sure enough, her oxygen saturations started dropping into the 70 % range.  I put the nasal cannula back on her and they instantly shot up to 100% again.  I looked over at the nurse, who pointed at the wall where I could read from across the room that the oxygen wasn't turned on.  I walked out of the room and wrote one additional order:  "cut nasal cannula prongs off of tubing and send home with patient." 


Monday, December 5, 2011

Neo makes a visit to the hospital...

This is from one of our ER doctors:

We quite often see patients come in from home invasions gone wrong.  One night, a young black man was brought in with a gunshot wound.  Apparently, he had set his gun down (this happens more often than you think) and helped his friend pick up a TV to carry out.  When he returned to try and retrieve the gun, he found the homeowner holding it with the business end pointed toward him.  Rather than do the sensible thing and run away, he decided to run straight toward the guy with the gun.  The homeowner, of course, fired a single shot, hitting the man.  He was subsequently arrested and brought to the ER for evaluation.  When the doctor examining him saw that he was hit only in the left buttock, he asked the officer who'd brought him in how that had happened.  Evidently, when the man was running toward the homeowner, he'd tried to pull some sort of ninja move half-way there.  When they asked the guy what he was doing later he simply stated, "Trying to dodge the bullet."


Sunday, December 4, 2011

Saturday, December 3, 2011


Seen in chart:

"Patient had a taco salad for supper."

No explanation, the sentence stood alone.


Friday, December 2, 2011

Things I wish I could write in a chart (but don't)...

"Reason for admission:  crazy family"

"Medicine consulted (at 3 a.m.) by a physician who makes twice what he does in order to write the phrase 'continue home medicines' in chart"

"Chief complaint:  'This is the only way my family will pay attention to me.'"

"Assessment:  Poor life choices led this patient to this end-point."

"Plan:  to avoid giving this drug-seeking patient any narcotics at all so they'll get fed up and leave against medical advice."

"Disposition:  get this patient the hell out of my hospital."

Thursday, December 1, 2011

Signs your child is a vampire...

Seen in a patient's room:

"So, what are we sharing today, little gir...OHMYGOD! What have you done!  Are those human spleens!

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