For those not in the know, a perfectly clear lumbar puncture sample (with no red blood cells) is called a champagne tap. So getting red wine after a lumbar puncture... Well...
So the lumbar puncture had red blood cells? 😬 Sounds the opposite of unremarkable. No wonder Neurologist was mad… I’m assuming that’s bad though. I have no idea!
I once described the pulse of a patient as "68 bpm, normal" to a nightmare cardiologist. He hit me with the "Normal? What's normal? How was the rate? the force? the rhythm? the wave? describe it, describe the wave, speak to me properly". Me, a baby med student, internally: "Idk, normal! He's here for a flu shot, leave me alone!"
I usually laugh at them. Because as we all know most of that information is useless and imprecise compared to an Echo. It is neat to know in severely underserved areas, but still echo. Same with some people's fixation on auscultation.
@@sciencefliestothemoon2305 you say that, I just ausculted a woman scheduled to go through a c-section and found arrhythmia, no one had examined her well before. We are doing an ekg later. Always auscult.
This tales me back to residency. I taught my medical students to do lumbar punctures and I promised them a bottle of wine if they had a clear tap. One of the students had one so the last night of the rotation I brought in a bottle of white wine. We couldn't find a corkscrew and we couldn't get the bottle open but we found that if use take a 60 cc syringe with a needle, you can insert it through the cork, withdraw the wine, and inject it into paper cups. Of course, that was about 30 years ago and would never fly today. Still one of the only positive memories of residency.
@@olmostgudinaf8100 Or you could push the air IN and force the cork out. However, I'm not sure if the cork would seal it enough, but if cork could be pushed in, it could be pushed out.
I'm not even in the medical field but I couldn't stop laughing. I'm that one person who got weird looks for saying I took a neuro-psychopharmacology course for fun though so 🤷😂
I got a champagne tap just once in my last year of residency (a sample of spinal fluid taken with no bleeding and zero red blood cells as a result), probably one of the highlights of my years in training. My attending and mentor got me a bottle of champagne the next day (was tradition to get champagne if you got a pristine clean non-bloody spinal tap and why Bill got red wine for a bloody one). I struggled often and was considered one of the weaker residents, basically the Bill of my class, so that meant a lot.
Ey rather a doctor that's had to struggle but got there eventually than a straight A never touched a book student that eventually kills someone with laziness and complacency in my opinion as a frequent flyer in the hospital :p Plus if you don't have a reputation you won't be too prideful to ask for help if you do fuck something up :') Rather hear my doctor admit they fucked up and call someone than stand there hands in hair like oh crap how do "I" fix this.
That’s interesting that neurology views LPs like that. I don’t think we give it much thought at all in radiology. Most of our taps are clear but if we get a trace amount of blood for the first second it’s whatever. Actual bloody taps are pretty uncommon but we also don’t think much of it just that they prob had a lot of scar tissue or bad osteophytosis/facet arthropathy requiring a lot of needle adjustment.
@reznovvazileski3193 x5 for nurses. I don't really care if you claim you've never made an error (med or otherwise) but I'm going to treat you as suspect if you do.
"If I wanted no information, I'd just talk to the emergency physician.... Yeah, that's fair" As a board certified emergency physician of many years, this cracks me up! Well played Doctor!
I'm not a medicine guy but as accurate as it is, I think it's a little savage... Emergency docs have enough on their plate to deal... Literally everything that comes to them is critical priority, we are lucky we have them... Expecting detailed analysis from them is too much.
Red wine. That is just brutal! I hope no one has ever been that mean in real life. (FYI it a tradition for attendings to bring a bottle of champagne to an intern the first time they do a lumbar puncture without getting blood in the sample. Not an easy task considering you have to go through tissue which has blood. A small amount of blood doesnt cause much problem, but a crystal clear "champagne" tap is beautiful)
Sounds more like a lot of interns get no to bad supervision. Hadn't had a traumatic tap ever, but some nice turbid milky ones (managed to tap all the big meningitis causes). Then again, good supervision.
I send these to my nephew, an ER Doc. He thinks it’s hysterical that the ER Doc always is dressed to ride 🚴. (On a side note, he hikes and rock climbs 🧗🏼♀️)😆
I had a lumbar puncture done, one of the newbies in records wanted to watch. All I heard when the first needle went in was "Oh my God," followed by a calm "Please don't say that."
"I can watch the individual neurotransmitters traverse your synaptic cleft." "..." "They made it!" "Opening pressure was 35." I lol'd. I joke sometimes about being able to see the individual gears turning in someone's head, but this expansion and punchline where the description of brain activity was literally accurate was beautiful.
My theory about Jonathan and Bill is that Jonathan is actually the future version of Bill who time traveled back after finishing residency to help himself out, but accidentally became a scribe. All the Jonathans are versions of Bill; he time traveled again and again to get out of being a scribe but failed.
I like this. I suspect after the first couple of timelines where he wound up as a scribe, he determined that it was the best and most powerful way he could accomplish his great works while remaining undercover even as an army of copied selves, so then it became more deliberate thereafter. I mean, if anyone could overcome a time travel problem and alter their tech so that the results suit their personal preferences, it's Jonathan!
A slightly more messed up idea I had: What if after time traveling for so long, Jonathan can no longer remember his life before? The Jonathan Nod(tm) is because he no longer remembers how to speak normally from being in so many timelines and meeting so many other Jonathans The ophthalmologist figures out that Jonathan can time travel after finding a time machine hidden and sends Jonathan back in time again and again to create enough copies of Jonathan for every ophthalmologist. It's all part of a master plan to make ophthalmology the best and most efficient specialty in medicine
@@sl33pl3ss9 This is shaping up to be quite the premise for an exciting and hilarious novel, or graphic novel. I'm getting Axe Cop vibes from the very dark, serious, extremely silly premise. I'd definitely read the dramatically illustrated adventures of Jonathan and his complex partnership with, and presumably his eventual great battle of good and evil with, the Ophthalmologist.
As a vascular neurologist... this is the BEST neurology skit ever! I have often had to ask residents: "is the LP negative for a NEUROLOGIST or just vaguely negative?"... The answer was always "vaguely negative"
I would love it if Bill ends with “actually there were zero red blood cells. You owe me a bottle of champagne” I can imagine an anti-Bill. They just randomly say to no one “the LP was unremarkable”. Neurologist turns up and says “excuse me?” Anti-Bill goes “great. You’re here. I have a consult for you……..” Reels off a comprehensive history and examination with a differential the neurologist can’t pick holes in, LP results and Whatever other test the neurologist would recommend already having been done. Finishes by pointing out their LP had zero red cells so someone owes them champagne. Neurologist just stands attempting to talk. Anti-Bill asks what’s happening. Psychiatrist comes over and whispers “he’s having an existential crisis as there is nothing he can belittle you for, I’ll have to take him from here”. Neurologist goes to therapy
Legit solid sketch concept, would love to see Dr. G develop a character of this nature. Some either -elder resident or hospitalist attending- (EDIT: ANOTHER COMMENTER NAILED IT, THE PERFECT CHARACTER IS A BAMF VETERAN NURSE) who just puts every bully in their place in a way the med student mafia can't always do lol (Also edit, I also support making her OBGYN's sister as suggested below, and I vote Mrs. G reappears for this role as well. Or Doc Schmidt in a wig!)
Oh heck yeah. I would absolutely watch just a wholesome music-backed compilation of Bill playing in a field with puppies or something lol. I really enjoy Dr. G's slow-motion dramatic work and visual storytelling, and I think this overall idea could be a cool playground for him to get to use that. Maybe he could make a hobby of visiting various cute animals and getting ice cream and stuff like that, in an occasional ongoing "Bill has a nice day" series. It would also be a good place to fit in messaging about self-care and turning off notifications for work-related things on a day off etc., so it can wholesomely resonate with his great narratives instead of just being a lighthearted break. Plus, what fun stuff to film!
@@ItsAsparageese I love this idea! Bill gets to lock up his pager(s) in some sort of vault for the day so he can really relax and enjoy the day before resuming the brutality of abusive hospital faculty and overwork. Poor Bill needs good days. Maybe he can bring Family Medicine along sometimes, too?
"Summarizing the results of a complex diagnostic technique simply as 'unremarkable'? When did you become a radiologist?" 🤣 As someone who codes radiology reports all day long, it's painfully true. Especially fun when "unremarkable" results are paired with no clear reason given for the exam so you have to try and figure out why they were doing it in the first place.
Having been in Bill’s position I can attest that the tendency of certain specialists to constantly belittle their juniors does not reflect best practice in HR or adult education.
(in awe) It's fascinating... I can actually see the individual neurotransmitters traversing your synaptic cleft... (slow motion parabolic tracing pause...)... They made it! OMG... Thank you for the laughs, from Australia. Gold!!! :)
Honestly Dr. Glauc I've watched your videos for a long time and as a person who's always hesitating in what I should pursue my residency in You inspire me to go to neurology. I can't help it. Nuerology is hands-down the best character(after jonathan) to ever exist .His tantrums his fine prickly attitude what's not to love about him..
This is all true. But do you really want to base your specialty and career on that? DrGlauc could do a video where Psychiatry compels Neurology to list all neurologic things that no other specialty cares about. It would run for hours. Neuro loves to play "find the lesion" on rounds. And it's a good mental exercise. But then the foolish med student says, "Okay, we found the lesion in the pons. What can be done about it?" and neurology says, "Oh, nothing can be done in neurology. Don't be silly."
@@NeuronToBrain 3 months later, you decide to respond with this? Really? I'm aware that he's "partially joking". All of his videos are at least partially joking. And my comment was partially joking too. Everyone except a few neurologists would understand this. Your extremely detailed, anal retentive response about neurology just confirmed every possible neurologist stereotype that DrGlaucomflecken ever portrays. I'll bet you're a hoot at parties. Do you know what a self-own is?
🤣🤣🤣 I stan the neurologist! Hands down the best Dr. G character. His egotistical, passive aggressive jabs are true to form for that speciality and beyond amusing!
The neurologist does look exactly like my Neurology attending in medical school except he wore a bow tie. Brings back such traumatic memories ... sigh.
Every time I see Neurologist, I cannot help but be in awe in how he gets his hair so high. It's quite facinating. 🤓 One day, Doc G is going to have to show us all how it is done. We will all tune in for that hair tutorial video. 😂
"I can actually see the neurotransmitters traversing your synaptic cleft.............. they made it!" And "You have expressive aphasia" 🤣🤣🤣🤣🤣 have me rolling lol
The two worst things you can hear as a med student: "What do you mean, the BMP was 'normal'?" and "I don't want all the numbers: just tell me if anything in the BMP was abnormal!" Bonus if it's the same doctor on two different days.
Man the neurologist has a super power. He can hear anyone who talks about any neurology-related stuff and be there in no time. I love him so much ❤️ Dr. Glaucomflecken I really appreciate your effort to put a smile on people's faces ☺️ thanks a lot and wish you all the best
I adore MY Neurologist! Thankfully he's nothing like this one, he's a well built, middle aged man with a white ponytail, looks like he could have been a Deadhead back in the day. He speaks to me as if we're on the same level without an ounce of arrogance. Wish I could say the same about my Neurosurgeon, but I don't need personality with him, just knowledge and steady hands.
Im a neurology resident, and I did my first LP the same day this video dropped. Mine's also a red wine tap though so don't beat yourself up too much Bill.
Thank you sir. These videos of u give me a weird sense of comfort. Was thinking of quitting bcz of all the yelling and mean attitude of everyone. But as now I see it, it's just the pressure
I am a patient who has had multiple lumbar punctures. When he didn't immediately know the opening pressure, I literally yelled "Dude!" at my computer 😆
Lol i love them both but I want to give Bill a hug. At least Neurology gave him a gift... A sarcastic gift but a gift non the less lol. Thank you and hope you are doing awesome and having a great weekend!!!
my father is a neurologist and literally has these glasses and made the exact same opening remarks last week about an ROS noted only as "OK" on a chart
Wow I had an almost identical experience this week of describing csf as unremarkable... I absolutely got roasted by my fellow and attending ... this hits so hard... probably also because I'm going into radiology
That EPIC masterpiece of hairstyle MAKES the character!!!! The perfect ice cream 🍦 swirl in the center had to have taken blow dry with a rounded brush and products to keep it in place! Well done!!! 👏👏👏👏👏❤️❤️❤️❤️
Got lectured by one doctor for not being more detailed. Then a week later I got lectured again by another doctor for not being more concise. Basically you can't win.
Bill sounds very much like the guy who did my lumbar puncture.; “Let me know if you have nerve pain down your legs because I’ll have to quit so I don’t cause nerve damage,” and then delayed listening. Ended up with permanent nerve pain since and a herniated disc diagnosed a week later after I had difficulty walking, sitting, and getting up. Fun times. Mine was “unremarkable” even though he had to quit due to too much pressure. Loved the referring physician’s: “Oh you can be up right away, at most in 30 minutes.” No one said a thing about not moving for 6-8+ hours minimum nor the likelihood of the horrendous spinal headache. God bless the anesthesiologist at the ER who did a blood patch for that thing.
Hahahahaha when did you become a radiologist! I had an ultrasound for several things and when they were talking about my pancreas they said it was “grossly unremarkable”. I’ve never been so thankful and insulted at the same time 😂🤣😂
You know, deep down, I think Neurology may be kind at heart. He didn’t just dismiss Bill and only ask for the results - he walked Bill through the results, helping him learn new information for the future. Neurology just needs to read a few, well-down positive psychology articles. Granted, that field isn’t known for its academic rigor, but there must be a few. Then, at the very least, he could try some positive teaching methods as a social experiment.
