Friday Night, 10:35 p.m.

"Hi, I saw Dr. Grumpy in 2007 or so, and had hurt my neck back then, and physical therapy helped. Anyway, I hurt it today carrying a bunch of boxes that my wife just HAD to get on Black Friday, and some asshole pushed me out of the way in the Wal-Mart toy section, and so I'd like to get some more therapy. It's hurting a lot right now, and I thought maybe there was a 24-hour therapy place you could send me to. Also, my internist said I'm due for a cholesterol panel, and something else to check my liver because I take a pill for my cholesterol, it's one with a long name, and maybe you could order those labs for me, too."

Voicemail Theater

The following 1 act play was left on my office voicemail this morning.

Female voice: "It says he's closed today."

Male voice: "Closed? Today?"

Female voice: "Yes. Closed. Today."

Male voice: "Why the fuck would he be closed?!"

Female voice: "It doesn't say. A lot of places are closed today. It's sort of a holiday."

Male voice: "That's bullshit. He should know better. What if a patient needs him?"

Female voice: "I can leave a message."

Male voice: "Yeah, but do we want him to call us back?"

Female voice: "It says he will."

Male voice: "I don't want him to. It's just not right that he's closed today."

Female voice: "Okay, what do you want me to do?"

Male voice: "Let's see if we can find another neurologist, with the decency to be open when patients need him."

(click).

November 27, 1898

111 years ago today...

Off the medical and humorous topics, I'm going to indulge my interest in maritime history this morning.

Everyone's heard of the Titanic, Andrea Doria, and Lusitania. But most shipwrecks are long forgotten, except in the areas they occurred.

Long before The Perfect Storm was made famous by a George Clooney movie, there was the Portland Gale of 1898. The storm was catastrophic, but is mostly forgotten now.

In 48 hours of early-winter gale over 300 ships were either sunk or seriously damaged. Lives lost is unknown, but likely between 500-1000. Shore towns and cities from Massachusetts to Maine were devastated by rain, sleet, and more than 2 feet of snow, driven by winds measured up to 110 miles per hour. Communities of summer beach cottages just vanished.

But the storm is still called by the name of it's most prominent victim: the steamship Portland.




In 1898 the Boston, Massachusetts to Portland, Maine route was a busy one, used heavily by both business and leisure travelers. Some took trains, while others preferred steamship. The latter traveled on coastal steamers, usually by night (the equivalent of a "red-eye" flight today). A ticket was $1 to $5, depending on your accomodations. You'd board in the evening, have dinner on the ship, sleep in your cabin, and the next morning were there. The ships went back and forth 3-4 times a week.

The New England weather can be notoriously vicious. A storm was coming in when the Portland sailed on the evening of November 26, 1898. Her captain, Hollis Blanchard, was known for being cautious, but apparently saw nothing in the conditions or forecast that unduly alarmed him. At 7:00 p.m. the ship sailed from India wharf in Boston, never to return.

The ship was sighted by others in the next few hours, but as the storm worsened, eventually vanished in the gale. When and exactly how she foundered will always be a secret, as she took all 192 passengers and crew with her. Recovered watches had all stopped between 9:00 and 10:00, though whether this was a.m. or p.m. is unknown.




The next day wreckage began washing ashore: furniture, timbers, luggage, lifebelts, and lots of bodies. Although the picture above shows a lifeboat being launched, none were ever found, and the severity of the storm makes it unlikely this was even attempted.

Several entire families were lost in the tragedy, traveling home after Thanksgiving in Boston. Their memorials are scattered across New England graveyards. The Portland black community was hit particularly hard, as (except for the officers) the majority of the crew were black men. In 1898 (33 years after the Civil War) service on these ships was considered a very respectable job for a black man, and those who served were generally veterans of the trade, supporting families ashore. They were often more sought after than white men for the same positions, as white men looking for these jobs were younger, less experienced, and seen as more likely to leave the job without notice.

The Portland herself would remain hidden for a long time. In 1989 the wreck was actually located, but the technology wouldn't allow an accurate identification. So it was forgotten again until 2002, when it was found by side-scan sonar. It's since been explored by divers, though at a depth of 460 feet in very cold water this is limited and dangerous.





So that's a history lesson for Friday. It seemed like a change of pace, and I needed to write a post, and I hope you enjoyed it. If you're interested in learning more about the Portland and 1898 gale, I recommend the book "Four Short Blasts" (the title refers to the whistle distress signal of the time) by Peter Dow Bachelder. The book also has a brief history of the American Life-Saving Service, which eventually became the U.S. Coast Guard.

Thanksgiving Memories

Let's take the Way-Back machine to the early-90's.

Dr. Grumpy is the medicine intern, on-call for Thanksgiving, at a large VA hospital (a veterans hospital for my non-U.S. readers, with consequently a primarily cantankerous elderly male population).

A peculiar thing about VA hospitals (at least back then, I haven't worked at one for 15 years) is that patients could sign out at the nurse's desk, and come back later (allegedly they were in the hospital because they were sick, but you need to work at one to understand this point). So the sheet was always full of notations that patients had signed out to go to McDonald's, or to buy cigarettes, or to smoke, or to visit friends at the homeless shelter, or to hold up a liquor store, or whatever.

Some bright businessman had opened a stripper club across the street from the hospital, I think it was called The Jaguar Room. So on Thanksgiving the VA ward I was covering was empty, as most of the patients had signed out to walk, wheel, or crawl over to The Jaguar Room for some female comfort and booze.

I was asleep in the intern's room when the calls began coming in. All of them from the bartender at The Jaguar Room. Questions about was it safe for my patients to be smoking through their tracheostomy tubes? Were the cardiac telemetry packs still transmitting from across the street? Was there a place at the VA where the patients could get more $1 bills, because they'd used them all up on the strippers?

And my favorite:

Bartender: "Can I give Mr. Veteran another beer?"

Intern Grumpy: "Um, what's the problem?"

Bartender: "He has one of those foley bags things, with the tube going up his dick. The bag is, like, REALLY full, and I'm afraid if I give him another beer it'll pop and send piss everywhere."

Intern Grumpy: "Send him back to the hospital."

Bartender: "Well, that's bad for business."

Intern Grumpy: "So is showering your clientele with piss."

Mr. Veteran was wheeled back over to the VA immediately, by a topless stripper no less, who waited while his bag was emptied and then pushed him back to the bar.

A happy Thanksgiving to all, and to all a good night.

Thanksgiving Morning

The kids are watching the Macy's parade on TV, and suddenly start laughing hysterically. I go in to see what's up.

The Rockettes are doing a dance number.

"Daddy! Those ladies aren't wearing any pants, and it's cold there! How could they all forget to put on their pants?"

Hospital Fun

I got called to the hospital yesterday afternoon. Nice old lady (80 +) who got a steroid shot in her back for pain. There were some complications with the shot, and she was (temporarily) paralyzed in both legs.

So, I checked her MRI to make sure nothing horrible had happened, and then went to meet with she and her husband. By the time I got there she was already improving.

Dr. Grumpy: "So you're feeling better now?"

Mrs. Oldbutcute: "Yes, but I was completely paralyzed for a while."

Dr. Grumpy: "Well, that was the medication, and it's wearing off now. It caused you to be dead from the waist down."

Mr. Oldbutcute: "Hell, doc, she's been dead from the waist down for 40 years."

He ducked as a copy of Newsweek came flying at him.

Anatomical Variant

From a history form a patient handed me today:

"I've had both right shoulders replaced twice."

Thank You For Sharing

Dr. Grumpy: "Do you take anything for the neck pain?"

Mr. Kreepy: "Viagra."

Dr. Grumpy: "Viagra isn't a pain medication."

Mr. Kreepy: "Yeah, but when I'm jacking off I don't notice the pain as much."

I need to learn not to ask. Sometimes I don't want to know. And the mental images are never pretty.

Medical Guidelines

Okay, medicine is full of guidelines and acronyms. Phrases like SOAP, BRAT, TURP, CAPRIE, HIT, CABG, CHOP, etc. all have meaning to different specialties.

So (and thank you to reader Kaitlin for bringing this to my attention) there's a scale used to help assess vomiting during pregnancy, called the Pregnancy-Unique Quantification of Emesis index, aka PUQE.

Really. PUQE.

I'm not making this up- Journal of Midwifery and Womens Health. 2009;54(6):430-444.

I can just see something like this:


Frantic husband: "Doctor, my wife is still throwing up!"

Doctor: "What's her PUQE index?"

Frantic husband: "Um, looks like pizza she ate last night, and maybe a cookie. Could be some pickles, too. Hard to tell."

Tuesday Evening, During Desert

Dr. Grumpy: "Dr. Grumpy, returning a call."

Mr. Duh: "Yeah, I was there this afternoon, and you told me to stop taking my Lipitor?"

Dr. Grumpy: "Yes, I did."

Mr. Duh: "And you wrote me a note, I have it here, it says 'Stop taking Lipitor'."

Dr. Grumpy: "Correct."

Mr. Duh: "So, does that mean I should stop taking it? Or just cut the dose in half?"

Dr. Grumpy: "It means you should stop it."

Mr. Duh: "Should I stop just the Lipitor, or should I stop stuff you didn't write down?"

Dr. Grumpy: "Just the Lipitor."

Mr. Duh: "Completely stop the Lipitor, you mean?"

Dr. Grumpy: "Yes."

Mr. Duh: "Okay, thanks for clearing that up, your note was kind of vague."

Averages Aren't Always Helpful

Dr. Grumpy: "At your last visit you were averaging 2 migraines a week, how has that been since starting the new medication?"

Mrs. Analytical: "Better" (whips out PDA) "The first week on it I went to 1.94 migraines, the second week I had 1.89 migraines, and the 3rd week I had 1.85 migraines. Last week, though was worse, and I had 1.91 migraines."

Dr. Grumpy: "How do you figure out these numbers?"

Mrs. Analytical: "I use accounting software."

Dr. Grumpy: "But how is 1.91 migraines different from 2 migraines?"

Mrs. Analytical: "The software says it is."

Not a Good Sign

On today's schedule, my first patient of the day is listed as "Mrs. Ancient, referred for memory loss".

I look in the lobby. She's out there, holding a magazine upside down. And she has her bra on outside her shirt.

Bartender, Gimme a Light

And a big Dr. Grumpy thank you to alert reader Allison, who sent me this.

Mary's Desk, November 23, 2009

Mary: "Dr. Grumpy's office, this is Mary."

Ms. Bright: "Yes, I need to make an appointment to see Dr. Grumpy."

Mary: "Okay, let me look... We can see you tomorrow afternoon at 4:00?"

Ms. Bright: "Oh, that won't work. How about at 5:00?"

Mary: "Sorry, that's when we close. Would earlier in the day be better?"

Ms. Bright: "No, I can only come in at 5:00 in the afternoon on any weekday."

Mary: "I'm sorry, our last slot of the day starts at 4:00."

Ms. Bright: "Okay, but if someone who has a 5:00 appointment cancels, can you call me?"