Happy pills

Dr. Action Potential has made no secret of her battles with anxiety and depression, and the fact that she takes Lexapro.

Does this bother me? THAT A DOCTOR IS ON A MEDICATION FOR A MENTAL CONDITION?

Absolutely not. I commend her for speaking out on it. Personally, if my doctor has a problem, I'd want them to be getting care for it.

Why do psychiatric disorders get "blacklisted" as a human condition? Insurance companies don't want to pay for them. Employers don't want to give time off for them. Relatives often don't believe in them ("Oh, she just needs to get over it. She's fine.").

The lady who has a heart attack and requires coronary artery bypass surgery gets time off from work, medications and doctors covered by her insurance, and cardiac rehab to help her recover. But the guy who has severe, nearly suicidal, depression? He may get a few days off work by calling in sick ("I have a cold.") He likely won't find help from a psychiatrist because his insurance doesn't cover them, and if he can't afford to pay cash he's SOL. If his boss learns what's really wrong with him he'll probably get fired.

His internist will try to help with some Cymbalta or Wellbutrin, but doesn't have the knowledge on what to do if those fail. Nor does she have the time to spend with him at his appointments because, as a primary doc, she's got a packed schedule.

So let's go back to your doctor being on Lexapro (or whatever) for their mental health. Does this bother you? Why? If your doctor was a diabetic wouldn't you hope they're taking their insulin like they're supposed to? Or blood pressure medication? A doctor who takes care of their own health issues is (hopefully) going to be around longer and capable of practicing better than one with out-of-control blood sugars or hypertension.

Yet, many people who learn their doctor was being treated for a psychiatric condition would probably run like hell from them. Why? If, like treating any other condition, it makes them better able to function, what's the problem? Wouldn't you want that?

Apparently not. Even though doctors battle the same demons as everyone else, AND are in a profession with one of the highest rates of depression and suicide, no one wants to hear that their physician may be on "crazy meds."

Insulin, Sotalol, Coumadin, Xarelto, Amiodarone, Herceptin, Tysabri, Cellcept, and many other potent meds for serious medical conditions - no one cares if their doc takes them. But Prozac? Hell, maybe you shouldn't be in practice.

So here's my confession: I'm on Zoloft (sertraline). I've taken it for 20 years. Don't like that? Think that means I suck as a doctor? I don't give a shit.

I've battled depression since I was a teenager (yes, for the doubting assholes out there, it's a real disease). I also have OCD. Not the personality type, but the actual disorder. Left unchecked, a circuit fires repeatedly in my head causing me to do pointless activities endlessly- checking light switches, counting to certain numbers repeatedly, walking in & out (and in & out) of a room. Those of you who don't face this have no fucking clue how awful it feels to know your repetitive actions are insane BUT YOU CAN'T STOP DOING THEM no matter how hard you try. Imagine being my wife dealing with that.

So, I take Zoloft. It's not a miracle drug for everyone, but in my case it works quite well. It keeps my wife from killing me for flipping the lights, or shower, or whatever, on & off too many times. It lets me focus on figuring out what's wrong with you, or playing basketball with my daughter. Got a problem with that? Go find another neurologist.

We might treat you for a mental illness, and wouldn't hold it against you, so why would you hold it against us? Or a lawyer, or decorator, or veterinarian, or politician (there's a lot you CAN hold against politicians, but this shouldn't be one of them), or plumber, or nurse, or accountant..., or anyone else for that matter?

I also take Lipitor for my cholesterol. Does that bother you? I doubt it. But I bet Zoloft would make you think twice about coming to see me. Why?

Your doctor, like me and Action Potential, is just another person, made up of the same organic chemical soup as you. We're going to have the same issues that you face (given the nature of this job, possibly more). And if we're willing to be treated for that, I personally think that's good. It let's us concentrate on taking care of you.

Which is, after all, why you came to us.

Your doctor can't help you unless they take care of themself first. No matter what their health problem is.

Mary's Desk

Mary: "Okay, so we have you down for next Tuesday, at 4:15."

Mr. Argue: "I'll be there. This is so exciting! I've always been stuck seeing general neurologists, and I'm so thrilled to finally be seeing someone at the famous Binswanger's Clinic."

Mary: "Um... we're not part of the Binswanger's clinic."

Mr. Argue: "Of course you are. The person who gave me your name said so."

Mary: "No... The Binswanger Clinic is in south Grumpyville, about 5 miles from here."

Mr. Argue: "But I want to be seen by a Binswanger neurologist!"

Mary: "Okay, but Dr. Grumpy isn't part of that institution. We're happy to see you here, but we don't have any affiliation with them."

pause

Mr. Argue: "Then cancel my appointment. I'm tired of settling for neurologist wannabes."

Veterans Day, 2014

Corporal Chester Nez, U.S.M.C.

Buried under headlines full of election-year vitriol, fighting in the middle east, conflict in Ukraine, ebola, comments by a basketball team owner, nuts with guns killing police officers and civilians, religious nuts with bombs killing anyone they can, and other cheery items... were 2 obituaries. Odds are that they didn't even make it into your local paper, or newsfeed, and even if they did you probably skipped them.

On June 4, a 93 year-old man died in Albuquerque of kidney failure. He was born in 1921 in Chi Chil Tah, New Mexico. Never heard of it? Join the club. It's an unincorporated area of land on an Indian reservation in western New Mexico. He could have been anyone's father, or grandfather, or great-grandfather, from that remarkable Greatest Generation.

But Chester Nez was so much more.

He was the last living member of a group of 29 men who were critical to the Allied victory in WW2.

They were the original Navajo Code Talkers.

You've likely heard the story to some degree. American forces needed an unbreakable code to fight their way across the Pacific. There was a successful one already in use, but it required a long time to transmit, receive, and decode at the opposite ends. And time, in the rapidly changing situation of combat, is one thing you don't have.

The U.S. had used Choctaw and Cherokee code talkers, with great success, in WWI (you probably didn't know that, either. Maybe I'll tell that story another time). In the buildup to WW2, however, the Germans were aware of this and sent anthropologists to the U.S. to learn as much about the native languages as they could. As a result they were used only on a small scale in Europe, with Comanche and Meskwaki talkers serving at Normandy and in Africa, respectively. Seminole talkers served in both Europe and the Pacific.

Navajo is a complex language. As of 1942 it hadn't even been set on paper, and was only known through oral teaching. It has a different grammar structure from other North American native tongues, and is indecipherable for those not familiar with it.

Philip Johnston, who'd been raised on the reservation in a family of missionaries, was one of the rare non-native speakers. In 1942 he approached the army with the idea, and they began quietly recruiting Navajo men. In tests under simulated battle conditions they found the talkers could relay an operational message in 30 seconds - compared to roughly 30 minutes using the standard encode-and-decode system. The cipher they finally developed was an odd combination of phonetic alphabet, straight words, and approximations (for when there wasn't a Navajo equivalent for English). Bombers became buzzards. Submarines were iron fish. Tanks were tortoises.

Codebooks to teach the new system were developed, but carefully watched and never left classrooms. Testing by U.S. codebreakers unfamiliar with Navajo showed that, to a non-speaker, it was unintelligible gibberish.

The Navajos were rapidly deployed. At Iwo Jima, home of one of the world's most iconic photographs, 6 code talkers operated continuously for 48 hours. They called in fire support, updated positions, relayed new orders, and allowed the commanders to quickly adjust to changes ashore. Major Howard Connor, commanding the Marines' signal division, later said that, without the Navajos, the island wouldn't have been taken.

It remains, to this day, the only spoken code that was never broken.

Not that the Japanese didn't try... Early in the war, at Corregidor, they captured Joe Kieyoomia, a Navajo serving in the army. Joe subsequently survived the Bataan Death March. He was viciously beaten by the Japanese, who thought his facial features meant he was of Japanese descent, and therefore a traitor. Eventually he was put in a concentration camp outside Nagasaki with other soldiers.

When the Japanese suspected the code was an Indian tongue, they tried to have Joe translate for them. He recognized the words, but since he didn't know the arranged structure and phonetics he couldn't understand it. As a result they tortured him even more viciously, then made him stand naked in snow. His feet froze to the ground, and when they shoved him back to his cell, the soles tore. Somehow surviving that... he went on to live through the atomic bombing, too. He died in New Mexico in 1997, and you probably didn't see his obituary, either.

Edmond Harjo, the last surviving Seminole code talker, died this year, too, on March 31, 2014. He was 96. He served in more territory than most, sending and receiving messages at both D-Day and Iwo Jima.

And the man I started the article with, Chester Nez, returned after the war and eventually became a painter at the Veterans' Hospital in Albuquerque. When he died on June 4, 2014 he was the last survivor of the original Navajo code talkers, who served with such great distinction far from home.

The nature of medicine

On call this past weekend, I was down in ER. They brought in a young guy who was killed in a bar fight. Massive head injuries. There was nothing that could be done.

And he was wearing a green T-shirt with a picture of a shamrock on it, that said "Today is my lucky day!"

A nurse commented this is the only field on Earth where such things are funny. She's probably right.

Question of the week

"Doctor, how do I know if I'm having a headache?"

I'm just here for the knives

Seen in a surgeon's note:

Thank you, Glen!

November, 1932

This week in 1932, a war was fought... One that would see the Australian military suffer what may be the most bizarre defeat in the history of armed conflict.


In the midst of the worldwide depression, Australia's Summer wheat crops were attacked by a marauding hoard of roughly 20,000 emus. The birds found it was easier to eat grain off cultivated rows than forage for it, and settled in.

"Our ancestors were Tyrannosaurs. Who's going to stop us?"

Emus are not small objects. After its cousin, the ostrich, it's the second biggest bird on Earth. They can't fly, but can kick viciously and run at over 30 mph. Their claws easily shred wire fences, and they're big enough to jump over or knock down most wooden ones. They can grow to a height of 6'6" and weigh up to 125 lbs.

In summary, they're not going to be threatened by a scarecrow. Or much else.

The farmers appealed to the government, and the Minister of Defence, Sir George Pearce, felt this was an excellent way of both assisting the farmers and getting his troops some target practice. Machine guns had helped break the Western Front stalemate in 1918, so would be ideal for mowing down a few overgrown sparrows.

They were just birds. What could possibly go wrong?

Major G.P.W. Meredith of the Royal Australian Artillery was the man tasked with boldly leading the expedition. He was given a group of soldiers armed with the latest machine guns, plenty of ammo, and orders to eradicate the birds.

He was also told to bring the feathers back for hats.

Upon arrival, the farmers and Major Meredith set up an ambush, hoping to kill most of the birds in one stroke. The farmers drove the huge flock toward where the soldiers were hiding... Only to have the emus break up into multiple small groups instead of staying in a large one.

Out of thousands, the machine guns killed... only 12 birds. More were wounded, but the soldiers found that shooting an emu didn't necessarily slow it down. In fact, anything short of hitting a vital organ just made them mad.

"Don't fuck with us, you overgrown monkeys."

Undeterred, Meredith courageously set up another ambush, this time cornering roughly 1000 birds near a dam. His men opened fire at close range... again with only 12 dead birds after much shooting. And one of the pricey machine guns broke.

An ornithologist later wrote that "The machine-gunners' dreams of point blank fire into masses of emus were soon dissipated. The emu command had evidently ordered guerrilla tactics, and its unwieldy army soon split up into innumerable small units that made use of military equipment uneconomic." In other words, the birds quickly scattered, and were damn near impossible to hit.

With the marauding emus showing no signs of leaving, Meredith changed tactics. In a burst of inspiration (likely from that great American strategist Wile E. Coyote), he borrowed a truck from a farmer, mounted a machine gun on it, and sent it racing into the flock

Sounds like something from a comedy flick at this point, huh?

"Trust me. I'm a professional."

To the Major's horror, the birds were easily able to outrun the truck. And, as they drove over the uneven landscape, the vehicle bounced so much that his men were unable to aim, or even properly work, the gun.

This experiment in motorized warfare came to an abrupt end when a heroic kamikaze emu turned around and ran directly into them. It's body jammed the suspension, causing the truck to spin out of control and destroy a farmer's fence. History didn't record who paid for the damages.

After a few days of similar front-line combat, Major Meredith sent a report estimating 200-500 birds killed, though the number was likely closer to 50. He also credited his opponents, who were able to keep running in spite of multiple wounds. "If we had a military division with the bullet-carrying capacity of these birds it would face any army in the world" he wrote. "They can face machine guns with the invulnerability of tanks."

He also noted that his own forces had suffered no casualties.

One soldier later gave this assessment of the enemy's strategy: "The emus have proved that they are not so stupid as they are usually considered to be. Each mob has its leader, always an enormous black-plumed bird standing fully six-feet high, who keeps watch while his fellows busy themselves with the wheat. At the first suspicious sign, he gives the signal, and dozens of heads stretch up out of the crop. A few birds will take fright, starting a headlong stampede for the scrub, the leader always remaining until his followers have reached safety."

The good Major withdrew in defeat, but was ordered back. This time his forces were somewhat more successful in culling birds... But still unable to seriously dent their numbers, or get them to leave the area. Some basic number crunching found that, on his best day, it took an unsustainable amount of costly ammunition to bring down 1 emu. It was a war of attrition, and the emus had the numbers. Faced with being beaten by birds, Defence Minister Pearce ordered a withdrawal and wished the farmers good luck.

Eventually, as news of the heroic military operation got around, there was a debate in the Australian government. It featured this memorable exchange:


Mr. Thorby: "Who is responsible for the farce of hunting emus with machine guns mounted on lorries? Is the Defence Department meeting the cost?"

Prime Minister Lyons: "I have been told the Defence Department will not be paying the bill."

Mr. James: "Is a medal to be struck for this war?"


Another minister later commented that if such a medal were struck, it should be awarded to the emus.

Although the farming community would request military intervention against the birds in subsequent years, the lesson had been learned and no further emu wars were launched.

Today, along with the kangaroo, the emu is one of Australia's national symbols, showing just which side came out ahead in the brief conflict.

"Primates! You know where you can stick your opposable thumbs?"

Overheard in ER

Nurse 1: "I need another urine sample cup for room 17."

Nurse 2: "Didn't you just give him one?"

Nurse 1: "Yeah. I gave him the cup and a Betadine swab. I told him to wipe himself first, then put it in the cup. So he wiped his dick with the swab, then put the swab in the cup."

Halloween memories - epilogue

For those wondering after reading Friday's post...

This, in memory of my grandfather, is the tie I wore. He bought it as an honest-to-God ordinary tie that he wore to his job. It is truly one of my most prized possessions, because, let's face it, ties this hideous aren't easy to find.

Sure, you can buy lots of gag ties that are intentionally horrid, but what makes this thing so awesome is that someone designed it in the 60's-70's as a serious tie for men to wear to business meetings, Bar Mitzvahs, whatever. And my grandfather paid good money for it and DID JUST THAT.

The day I found it in his closet, I knew I'd stumbled on something rare and worth keeping. Someday I'm sure one of my descendants will do the same.

The picture doesn't do the bright colors justice. The vibrant reds, oranges, pinks, yellows, golds, whites, and a few previously undescribed hues make a pattern so striking... It looks like Roy G. Biv threw up.

Also, it's so wide at the bottom that you could wear a midriff shirt and no one would notice.

Yes, I really did wear it to work. Be jealous.

Halloween Memories

A long time ago, in a medical office building far, far, away...

As my regular readers know, before I went solo I worked for a large group called Humungous Neurology, Incorporated (HNI).

I left them for a lot of reasons, one of which (as is usually the case) was money. I won't go into too many details, but when I left my "contract-guaranteed" salary had been slashed by roughly 75% (to less than I'd made as a resident) because the money was needed for "the research budget."

By coincidence, my last day working for HNI happened to fall on Halloween.

So that day I came to the office (with a full schedule of patients) wearing an old pair of pants that I'd used to paint the house, a shirt with holes in it, a sock on only 1 foot, a pair of badly mismatched rundown shoes, and, for the pièce de résistance, this horribly hideous 70's era tie that I found while cleaning stuff at my grandparents' house.

When people asked me what my costume was, I told them I was an HNI neurologist, who couldn't afford decent clothes.

Repeating oneself... a symptom of...

Medication list from a patient (highlights added).

For those not in the medbiz, Donepazil is used for Alzheimer's disease.

Thank you, Gary!

Skool Nerse time

This is Mrs. Grumpy.


Kid wanders into my office.

Nurse Grumpy: "What's up?"

Kid: (wailing) "I was playing in the sandbox and got sand all over my hands and under my fingernails!"

Nurse Grumpy: "Have you tried washing your hands?"

Kid: "Ummm... No."

Nurse Grumpy: "Go wash them in my sink over there. Use soap."

(Kid washes hands)

Kid: "It's all better now!"

Nurse Grumpy: "Okay, go have fun."

Kid: "I'm going back to the sandbox. What a neat trick!"

Doctor's lounge, Sunday morning, 6:18 a.m.

Cardiologist: "The coffee machine is broken."

Neurosurgeon: "Ah shit. I really needed some, too."

Neurologist: "I don't think they come in on weekends to fix it, either."

Pulmonologist: "They don't. We're fucked."

Cardiologist: "Maybe we can do something..." (Opens front of machine).

Neurologist: "Wow, what a mess."

Neurosurgeon: "I think this thing that fell over holds the used grounds."

Neurologist: "Yeah." (dumps grounds in trash, rinses holder in sink, puts it back in machine).

Nothing happens.

Pulmonologist: "It's still not working."

Neurosurgeon: "Let me see... Here, look. The part that feeds the filter paper roll got doubled up and twisted. It's stuck."

Neurologist: "Hang on..." (pulls out filter paper roll) "Ah, okay, looks like it wasn't put in correctly. Let me turn it around and toss the jammed paper."

Machine starts gurgling.

Pulmonologist: "It's working! Yay! Coffee!"

(All get coffee)

Cardiologist: "That's amazing."

Neurosurgeon: "The coffee gadget?"

Cardiologist: "No. For the first time in medical history it was a neurosurgeon who made the correct diagnosis, and a neurologist who fixed it."

The pulmonologist blew her coffee all over the bagels.

Dog WIN!

Christmakuh is coming

So, if any of you guys have horrifying gift ideas you'd like to submit for this year's catalog, please send them in!

It's just a jump to the left

Seen in a cardiologist's hospital dictation:

Dear American Medical Association,

Thank you for the brochure I received from you and Mercedes-Benz, making me aware of the great car deals available to physicians.

I'm glad to see the AMA is still living in some sort of fairytale land where doctors have money trees growing in their yards. This sort of stereotype only fuels the already crappy image the public has of us.

Here's the reality: In 2013 (my worst year ever, due to several factors) Dr. Grumpy's solo practice salary came out to $99,354. That's working 60-70 hours per week, with 4 weeks of vacation.

Now, I'm NOT (emphasize NOT) complaining or bragging. I'm just stating this as a fact, to make a point. I know there are MANY people who'd be grateful to be able to make that. I'm thrilled to have a job I like that allows me to support my family.

But the reality is this: I drive a 14 year-old Nissan Maxima with the passenger door smashed in. Sending me a booklet telling me that, as a "qualified physician," I can save $1000 off a $92,000 S-Class sedan, $3000 off a $72,100 CLS-Class coupe, $4000 off a $116,000 CL-Class coupe, $3000 off a $114,200 G-Class SUV, or $3000 off a $106,700 SL-Class roadster... just shows me how fucking incredibly out-of-touch you guys are with the reality facing today's doctors.

Granted, I'm not a member of your organization. Honestly, I'd rather spend the $420 annual fee on my kids. To the best of my knowledge, an AMA membership gets me a journal I don't have time to read, discounted admission to an annual meeting I won't go to, and, obviously, a token discount on a car I can't afford. In fact, if I was a member, I'd be pretty pissed to find out this is what you were spending my annual fees on: getting me a deal on an imported car that costs more than I made last year.

American medicine is in a serious crisis right now. I'm not going to take political sides, as there are plenty of blogs for that. But my point here is that you guys are obviously clueless as to how much docs are really making.

Not to mention medical students. The next generation of docs are coming out of school $200,000 in debt. Residency pays maybe $40,000 a year, and they're at the ages where they're starting families, buying first homes, etc. Then they get to go earn practice salaries that (like mine) are dropping each year. So realistically the only "luxury automobile" they'll get to ride in... is a hearse.

Note to medical students- if you're doing this thinking you're going to get rich, just stop now and cut your losses. In fact, I'd get out regardless of why you're doing this.

But, I'm glad to see you AMA guys are on the ball. I'm sure there are SOME doctors out there who can blow that kind of money on a car (likely all on your board of directors) and it's reassuring to know you're doing something to benefit them.

The rest of us hard-working docs trying to practice ethical front-line medicine will stick with our old cars with the sides smashed in.

With a capital E

Mrs. Eword: "So, anyway, I want an MRI, and can do it today."

Dr. Grumpy: "I agree with getting one, but your insurance requires a pre-authorization. I'll have my staff get started on that, but it takes a few days and..."

Mrs. Eword: "I don't think you heard me. I want it NOW. While I'm here."

Dr. Grumpy: "Well, it has to be scheduled with an MRI facility and your insurance. I don't do them here."

Mrs. Eword: "What do you mean you don't do them here? You're a neurologist, aren't you?"

Dr. Grumpy: "Yes, and I order MRI's, but don't have the machine in my office. We use Local MRI, across the street and..."

Mrs. Eword: "I cannot believe this. What's that room I passed with the door closed down the hall here? There was a lot of noise. Isn't that your MRI?"

Dr. Grumpy: "Uh, that's the bathroom. They're replacing the sink's pipes today."

Mrs. Eword: "So you've been wasting my time this morning. Doesn't other peoples time mean anything to you? This is incredibly inconsiderate."

Dr. Grumpy: "I..."

Mrs. Eword: "I'll go elsewhere." (gets up, leaves)

Bite me

The kids had a healthy breakfast of Costco chocolate muffins yesterday, one of which had a minor defect.

But they felt the need to text it to me:

Details

I'm with a patient, when Mary knocks on my office door.

Mary: "Dr. Schnozz is on the phone, says he needs to talk to you ASAP."

Dr. Grumpy: "Excuse me..." grabs phone "This is Dr. Grumpy."

Dr. Schnozz: "Hi, we have a mutual patient, Mr. Platelet, and he was here with his wife a short while ago for his sinuses. Anyway, I'm concerned he needs you to work him in urgently."

Dr. Grumpy: "What's up? I mean, he was just here this morning at 9:00."

Dr. Schnozz: "Really? They didn't mention that. Anyway, he's weak on his left side, and I'm worried he had a stroke."

Dr. Grumpy: "He DID have a stroke. I had him in the hospital last week for it, and I saw him today in follow-up. He's weak on the left, and I ordered physical therapy."

Dr. Schnozz: "They didn't tell me that either. Never mind."