Behind the Medic: There's no app for that, either.
  • Colleague:...but after taking 8 acetaminophen and 6 ibuprofen in 4 hours, she started vomiting.
  • Nurse:Oh, so ~THAT'S~ why she's vomiting.
  • Colleague:Yep. God gave our bodies a few useful reflexes to help undo our stupid decisions.
  • Nurse:Yeah. Too bad there isn't an anti-stupid reflex, though.
TSK: 50-something male with a 15-something grasp of science

4-inch-long full-thickness laceration of the shin, from an old soda can kicked up by a lawn mower blade.

Tibia is visible through parts of the wound, which is contaminated with dirt and grass and who knows what.

Last tetanus shot “probably 20 years ago or more”; declines tetanus booster shot today – reason?

“My immune system is strong enough, those vaccines just weaken you." 

Behind the Medic: Zpak Alternatives

Been working on a Cranquis Mail reply about antibiotic overuse. Just had a great idea for some alternatives to the Zpak (azithromycin, an antibiotic often demanded by patients) – I need to patent these ASAP:

  • See?Pak – 6 combo tabs of azithromycin + a powerful laxative, designed to emphasize my warning that “antibiotics can have many side effects, including diarrhea.”
  • Zpak 90x – A homeopathic 90x dilution of azithromycin, for people who actually NEED an antibiotic but refuse to take anything that “isn’t natural.” (Note: dosing requires 180 tabs the first day, 90 tabs each day after, for a total of 90 days.)
  • Zpatch – Adhesive patch impregnated with topical azithromycin, to apply directly over the chest of people with viral chest colds. (“Studies proved Zpatch has equal efficacy as oral Zpak for people with your illness!”)
  • PlaZbo – Sugar pills packaged in old Zpak containers.
TSK: I have the utmost respect for your idiocy.

Ok, parents of the 3-month-old girl with a high fever and diarrhea – let me get this straight:

  • You all just returned from 3 weeks visiting family in Mexico.
  • While in Mexico, little Ayeli had “a cough and runny nose, no fever” and you took her to a doctor who gave her a shot of penicillin (yay, modern Mexican medicine!) plus 3 days of oral penicillin. She “got all better in 3 days” (wow, big surprise, a cold getting better in less than a week!).
  • Now she’s had “black watery diarrhea” for 3 days, and a fever since last night (although, of course, you have no idea what temperature it was because you don’t own a thermometer). Here in my clinic, her temp is 101.5 degrees.
  • Her flu and strep tests are negative here, her chest x-ray looks fine to me, her ears are fine, her lungs sound fine, her throat looks fine, there’s no rash.

Ok, all that being said: you absolutely refuse to let me get a catheterized urine specimen to check for a bladder infection. “Is that really necessary?” you ask. “The doctor in Mexico didn’t do that!” you exclaim. “We don’t want to cause her any pain!” you wail. “Would you do that to your own child?” you challenge. (To which I answered, “Yes, in this situation at this age, yes, I would.”)

Oops, you’re absolutely right! I was just gonna have my nurse stick a tube up your child’s urethra for the pure giggles of it!! You caught me – I’m a sadist! And obviously that doctor in Mexico is the world’s expert on diagnosing Fever of Unknown Origin, since he pre-emptively put her on antibiotics before a fever even BEGAN! I’m certain that the injected penicillin hurt much less than a 30-second catheterization, too! I quiver in the presence of your genius! Here, take this prescription pad and go get her something nice at the pharmacy!!!! It would also be really nice if you’d condescend to doing these stool tests I’m ordering to see if she’s bleeding internally from some yummy enteric pathogen – but if that’s too gross for you or something, don’t fret about it – seriously, who dies from diarrhea nowadays?! Oh and when her fever doesn’t go away by tomorrow, don’t come back to my clinic, because the first thing I’ll do it stick a catheter in your child’s urethra while praying that she doesn’t have a bladder infection headed for her kidneys and All Points West!

I walked out of that exam room and told my nurse: “My new motto is: You can lead a horse to water, but you can’t make it think.” I’m pretty proud of being able to come up with that from within my cloud of blinding rage at that moment.

TSK: There's a-hole in your theory

Dear father of the “boy with wheezing for past 6 weeks”:

I’m not upset that you waited that long before bringing him in to the Urgent Care for “coughing all the time and wheezing at night, but only when he is in the house.”

I’m not upset that you caused his breathing problems in the first place,  by “throwing handfuls of mothballs into the walls and the heating vents 6 weeks ago, to get rid of the mice in the house” – so many mothballs, in fact, that people who visit your house tell you that “it smells like mothballs in here.”

No. What has me ticked off is that you went home from our visit, and told your wife that “the mothballs have nothing to do with the boy’s breathing problems” and “we don’t need to try to get them out” – which was the EXACT OPPOSITE OF WHAT I TOLD YOU.

How did I find out about your blatant lie? Happy coincidence – since I’m the same doctor who saw your wife the following week, when she came in for (wait for it…): “wheezing and short of breath whenever I am in my house for past 7 weeks.”

TSK: Not sure what you want from me, lady...
  • 50-something female patient (here for "painful urination for 8 days"):What took you so long to come back?
  • Cranquis:Um, the urine test takes 3 minutes to run, sorry about that. The result definitely shows a bladder infection.
  • Patient:Well DUH, I told you I had a bladder infection when I came in here, like FOREVER ago.
  • Cranquis (glancing at computer, which shows she has been in our clinic for a grand total of 15 minutes so far):Well let me just send off the antibiotic prescription for you and...
  • Patient:I don't want any antibiotics! I just wanted to confirm I had an infection.
  • Cranquis (glancing at computer, which shows that it only FEELS like I've been in this room for FOREVER):...
TSK: Stupid-sense, tingling!

Hey hey, Constant Readers! Now that you’ve been reading my blog for a while, you’ve probably started to develop a Stupidity Sixth-Sense for patient scenarios that are just about to “go for a trip to Stupid Town.”

So, let’s put your new ability to the test: read through this patient’s story line by line, and note which line first causes your SSS to start ringing (MINE started buzzing at line 2, and was howling by line 3).

Patient: 75-year-old male with “shoulder and neck aches”.

  1. “Well, last weekend I was at a restaurant with my 15-year-old grandson, and we played one of those arcade games where you shoot basketballs.
  2. "He kept making the baskets, and I could barely get the ball to hit the rim.
  3. "So yesterday, I went to the gym and tried shooting some baskets, and I still couldn’t get the ball up to the rim.
  4. "So I went over to the weight area, and lifted weights for 2 hours.
  5. "Then I went back and tried shooting baskets for another hour.
  6. "I never did make a basket, so I went home.
  7. "This morning, I woke up and my neck was killing me, and my shoulders feel stiff.
  8. "Do you think I got meningitis from someone at the gym?” (By this point, I was trying so hard to NOT laugh, that I was chewing the inside of my cheeks!)

Scoring: If your SSS started tingling at…

  • Line 1: maybe you are a bit too cynical.
  • Line 2: you obviously have prior experience with real patients.
  • Line 4: you are a rational human being.
  • Line 7: you know the shortest way to the bus stop.
  • Line 8: you need remedial work; please go read some other “stupidiot” patient stories.
  • Just now: please don’t ever become a doctor. :)
TSK: My buddy w/ Fibromyalgia gets crappy advice

Buddy *text message*: Hey Cranquis, what do you think of this message I just got from my friend? “Fibromyalgia is a 100% spiritually rooted disease. What is happening in the physical is showing you what is happening in the spiritual. The roots of this disease are fear, anxiety, stress and often resentment. How does that hit you?”

Cranquis: Tell your ‘friend’: “Me slapping you is the physical manifestation of my spiritual condition when you tell me that my mind and spirit are strong enough to "fool me” into feeling physical pain, but too weak to properly cope with the hypothetical fear/anxiety/stress behind it. How does THAT hit you?

If you are older than 12, and you show up with a marble in your nose, prepare to receive a bit of mocking from your doctor. Just sayin’.

(Today’s winner: 17 years old – “I was just pretending to stick it in there, and…”)

Bad and Worse: No more camping for you, ma'am.

Bad: Getting a tick bite in your arm.

Worse: Not having tweezers to pull it out, so settling for using your teeth to grab the tick and yank until its body rips off.

Worst: Deciding that you need to “burn the head out”… by repeatedly mashing a lit cigarette into your skin, leading to a skin infection by the next morning.

(Yep, she’s got an infected burned tick bite… some kind of weird Infectious-Disease/Plastic Surgery perfect storm. And no, it didn’t look like domestic abuse – she’s just not very bright.) :S