Dr. Cranky Hates Cell Phones!

Greetings gentle reader. Once again it is time for Dr. Cranky, your raucous raconteur, to take to his keyboard and release the pugnacious humors which have been building within his tortured spleen! Your humble servant has so much he wishes to repine about, yet so little time is available given the constraints of his daily battle with the Angel of Death. It was during one of his recent shifts that the topic of this latest diatribe came upon him with all the subtlety of a hammer to the forebrain.

There comes a time, far too frequently, when despite his best efforts Dr. Cranky’s patients want to do things which are not in their best interests. The patient in question, whom we shall refer to as Ms. H, had presented to Dr. Cranky complaining of a headache. Although this otherwise reasonable woman had experienced minor headaches in the past, this one was different. It had come upon her suddenly, like a clap of thunder, with full intensity at onset and was unlike anything she had ever experienced before. There are phrases which send chills down the spine of any seasoned emergency physician, and a chief complaint of “the worst headache of my life” can be found toward the top of the list.

Your faithful yeoman immediately considered the possibility of a subarachnoid hemorrhage as the number one concern in his differential diagnosis. The brain is surrounded by tissue known as the arachnoid membrane, and bleeding in the space beneath this structure occurs when a blood vessel ruptures, either spontaneously from an aneurysm or through traumatic injury. It can be fatal if not diagnosed properly. In fact, some years ago a friend and colleague of Dr. Cranky’s suffered from this unfortunate malady and died at the tender age of thirty-two.

You may experience a little discomfort

The difficult thing about a subarachnoid hemorrhage is that this bleeding may not show up on a Computed Tomography scan. In fact, it has been recognized that a head CT has the potential to be falsely negative in up to 15% of these cases. Needless to say, a good emergency physician does not want to miss a single patient with this dreaded infirmity. It is for this reason that a normal CT should always be followed by that sacred ritual known as a lumbar puncture whenever one suspects this diagnosis.

To the uninitiated a lumbar puncture, also known as a “spinal tap,” has an undeserved reputation. Everyone knows a friend of a friend of a friend who once met someone who spoke with someone who heard about an acquaintance who had a relative who underwent this procedure and OH MY GOD, HORRIBLE THINGS HAPPENED (although exactly what took place is never specified)!!! Such stories permeate the collective unconscious of our society and fill patients with obstinate dread. And indeed, the procedure sounds grisly. After all, it is Dr. Cranky’s desire to cleanse his patient’s back with betadine, inject 1% lidocaine in the L4-L5 interspace and insert a 22-gauge spinal needle between the vertebrae and into the spinal canal itself.

Yes, Dr. Cranky is asking for permission to stick one of these into your spine

The spinal fluid thus obtained is sent to the laboratory for analysis.If there are an abnormal number of red blood cells the diagnosis of a subarachnoid hemorrhage is made and the patient is whisked down to BCMC to meet with their friendly neighborhood neurosurgeon for further evaluation and therapy.Is it any wonder patients believe this procedure to be derived from nothing less than the perverted machinations of a modern-day Tomás de Torquemada who is bent on making them confess the most heinous of heresies?

In reality an LP is not nearly as bad as one would suppose and, if done properly, is almost painless. Realizing that no sane person would allow someone to do such a thing outside of a George Romero movie, Dr. Cranky tries to provide a little perspective. He starts off by asking his female patients if they have any children. If they answer in the affirmative your host next inquires if they had a procedure commonly known as an “epidural” to ameliorate the discomfort of childbirth. If they assert, once again, that such is the case Dr. Cranky educates them to the fact that a lumbar puncture is the exact same thing as an epidural with just one difference; during an epidural a small amount of anesthetic is injected into the spinal canal whereas in a lumbar puncture a small amount of spinal fluid is removed. Upon hearing this news most reluctant patients realize that, as FBI Agent Dale Cooper from the television show Twin Peaks would say, “things are not what they seem” and acquiesce. Sometimes however, as with the case of Ms. H, they still decline despite the fact that this is the only way to rule out a truly horrible life-threatening condition.

It is at this point Dr.Cranky brings out his secret weapon. It does not involve such crude instruments as leather restraints (although he is more than familiar with these kinky devices), nor does it involve powerful sedatives. After all, it is unethical for a physician to force care on any patient who is of clear mind regardless of the consequences. No, your humble servant can be a much more subtle and devious bastard when he so desires. Psychological warfare is needed to win the day. When Dr. Cranky really wants to tighten the screws in the process of looking out for someone’s health and well-being he calls upon nothing less than the patient’s own family!

In medical practice a little theatrics can go a long way, and in such situations Dr. Cranky has the entire family ushered into the room. In the case of the reluctant Ms. H, your faithful scribe sat next to his patient and carefully outlined to her loved ones why he was worried about the possibility of a life-threatening disease. He explained why a CT of the head did not rule out dire consequences and that the only way he could give them peace of mind was through the dreaded “spinal tap.” He then expounded how an LP was really not as bad as they might imagine and that it was nothing more than the pain-relieving epidural they were all familiar with save for one small difference. Ms. H’s very life was at stake! If only she would relent!!!

There was silence in the room. The atmosphere was somber and filled with drama worthy of any episode from ER.The patient and her family looked at each other without saying a word. Tension was building, and Dr. Cranky could see that Ms. H’s resolve was going to crack. She looked down and then back to your earnest host. She opened her mouth, about to relent, when suddenly the room was filled with a horrid discordant cacophony . . .

“Bugida, Bugida, Bugida, YEAH!”
“Bugida, Bugida, Bugida, YEAH!”
“Bugida, Bugida, Bugida, YEAH!”


Dr. Cranky’s shoulders slumped. Across the room Ms. H’s daughter desperately searched through her purse. Once again, her cell phone announced its presence in the most annoying manner possible.

“Bugida, Bugida, Bugida, YEAH!”
“Bugida, Bugida, Bugida, YEAH!”
“Bugida, Bugida, Bugida, YEAH!”


Dr. Cranky tried to salvage the situation as best he could, but before he could utter another word he was interrupted once again by that hideous ringtone.

“Bugida, Bugida, Bugida, YEAH!”
“Bugida, Bugida, Bugida, YEAH!”
“Bugida, Bugida, Bugida, YEAH!”


It was no use. The moment had passed. All was lost as Ms. H regained her fortitude and voiced her declination. Defeat had been snatched from the jaws of victory. Dr. Cranky had been undone by that most horrid of modern conveniences known as the cellular phone.

About Dr. Cranky

Dr. Cranky is a residency-trained, board-certified emergency physician who has been fighting in the trenches of American medicine for far too long. Each day he tries to stay one step ahead of burnout. Despite his best efforts, burnout seems to be closing in fast.
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