Now THAT'S ambitious!

I'd like to thank my reader Miriam for submitting this. She noticed it in a hospital patient's (admitted for a knee problem) paperwork .

(click to enlarge)

And now for something completely different

Okay, people. Yours truly, Dr. Grumpy, has been asked to host (drum roll please) ONLINE GRAND ROUNDS next Tuesday. As many of you know, this is a weekly collection of blog posts of a certain theme.

Next week starts the 7th year of this, and they wanted someone talented, popular, and successful to host it. Unfortunately, that person wasn't available, and so they asked me instead. I've been assured that their decision to pick me was based on stringent criteria, such as having a pulse and a website. I tried to negotiate for a case of Diet Coke, without success.

So the topic for next week's Grand Rounds will be "Things that make me grumpy". I whine enough, so I'm opening up the floor to you guys. Please submit links to blog posts following this theme, but try to keep them (roughly) in some limits:

1. They should have at least SOME medical background to them. I don't want to hear about the guy who cut you off in traffic (unless it was a neurologist wired on Diet Coke), the crappy service you got at Denny's, or the high cost of flour.

2. Try to have some element of humor in it.

3. This is NOT a political blog, so I'm NOT going to put up rants from either side about health care, elections, or whatever.

How to submit: Please send your entries to pagingdrgrumpy [at] gmail [dot] com. Put "Grand Rounds" in the subject line, and include the URL of the post in the message, with a sentence or two about it. Sending huge amounts of money to my Paypal account is also recommended, but not necessary (nudge nudge wink wink).

The deadline will be Saturday, September 25, at 6:00 p.m. U.S. Eastern time. So submit early. Or else.

Urgent matters

Dr. Grumpy: "Have a seat. I'm Dr. Grumpy."

Mrs. Arowana: "Thank you. Pleased to meet you."

Dr. Grumpy: "What can I do for you?"

Mrs. Arowana: "Well, for the last 7 years I've had... Oh! I need to leave. I'm sorry!"

Dr. Grumpy: "Is something wrong?"

Mrs. Arowana: "I forgot to turn on the light in my fish tank after I cleaned it this morning!"

Dr. Grumpy: "But..."

Mrs. Arowana: "No, I have to go deal with this. The fish are my babies, and I don't want them to get angry at me."

(patient walks out)

Dear Ambien-CR,

Thank you for recently sending patient information packets to my office (I've already safely recycled them, don't worry).

I know your logo is a rooster. I still don't understand this, since the drug is supposed to make you fall asleep, NOT wake you up. But whatever.

Anyway, considering another term for rooster is "cock", and we all know what that's slang for, perhaps you should think of a better package design than this. Or maybe license the logo to Viagra, instead.

Because somehow I can just see this ending up in a novelty store next to a mistletoe belt buckle.

Dead men tell no tales...

Yo ho, yo ho, a pirate's life for me!

We pillage, we plunder, we rifle, and loot,
Drink up, me hearties, yo ho.
We kidnap and ravage and don't give a hoot,
Drink up me hearties, yo ho.

Yo ho, yo ho, a pirate's life for me!

We extort, we pilfer, we filch, and we sack,
Drink up, me hearties, yo ho.
Maraud and embezzle, and even hijack,
Drink up, me hearties, yo ho.

Yo ho, yo ho, a pirate's life for me!

We kindle and char, inflame and ignite,
Drink up, me hearties, yo ho.
We burn up the city, we're really a fright,
Drink up, me hearties, yo ho.

We're rascals, scoundrels, villains, and knaves,
Drink up, me hearties, yo ho.
We're devils and black sheep, really bad eggs,
Drink up, me hearties, yo ho.

Yo ho, yo ho, a pirate's life for me!

We're beggars and blighters, ne'er-do-well cads,
Drink up, me hearties, yo ho.
Aye, but we're loved by our mommies and dads,
Drink up, me hearties, yo ho

Yo ho, yo ho, a pirate's life for me!

Aaargh! Happy Talk Like a Pirate day, mateys!

Rolling on the River

It was the American Civil War.

In February, 1862, the city of Nashville, Tennessee, was captured by Union forces. This began one of the strangest episodes in North American military history.

Overnight Nashville was converted into a supply depot for the Union's southward moving forces. The amount of locomotive and riverboat traffic increased dramatically, as did the population of Union soldiers. Some were stationed there, others were passing through on their way to different fronts.

And prostitutes, the eternal ancillary business to military campaigns, became prevalent. An area of town called Smokey Row (named after the opium dens) featured over 70 brothels. Aside from thousands of soldiers, rumored clientele included Lincoln's future assassin John Wilkes Booth, and Lincoln's successor to the Presidency, Andrew Johnson (no link aside from coincidence has ever been uncovered).

Syphilis and gonorrhea were rampant. Soldiers and prostitutes equally became ill from diseases spread in Smokey Row.

Pvt. Franklin Bailey wrote his mother that he'd need a dictionary "to find words enough, and then I could not find them bad enough, to express my hatred of those beings calling themselves women" in Smokey Row. Later in the same letter, however, he tried his best (perhaps he borrowed a thesaurus) and wrote that they were "abominable, low, vile, mean, lewd, wanton, dissolute, licentious, vicious, immoral, and wicked."

Pvt. Bailey, however, was an exception. The general feeling of most troops was that "No man can be a soldier unless he has gone through Smokey Row"

The Union commanders were less concerned with morals than they were with military capabilities. With many of their troops hospitalized from sexually transmitted diseases, the ability to launch further military campaigns was impaired.

Punishing soldiers didn't help. Nor did medical lectures. And antibiotics were in their infancy.

Something had to be done. Since the soldiers were needed to fight the war, they couldn't leave.

And so, on July 6, 1863, General James Morgan issued "Special Order No. 29".

This order basically said that prostitutes in Nashville were to be rounded up and sent somewhere else. How and where weren't specified.

And so into the picture entered a plain 3-month-old steamboat named Idahoe and her captain/owner, John Newcomb.

Idahoe was one of many steamboats at the waterfront under charter to the army. History has not recorded why she was chosen out of the many available.

Union forces rounded up hundreds of women from Smokey Row, storming buildings and catching women who tried to jump out of windows to escape. Non-prostitutes were also inadvertently nabbed in the confusion, just from being too close to that part of town during the operation, and required family to free them.

On the morning of July 8, Capt. Newcomb was finishing his breakfast coffee on board the Idahoe, when he was assaulted by noise. As he walked to the gangplank he was met by Colonel George Spalding, who handed him an order that read, "You are hereby directed to Louisville, Kentucky with 100 passengers put on board your steamer today, allowing none to leave your boat before reaching Louisville."

Even as Newcomb read this, the ladies were being driven on board. He was given no money to buy food for them, nor guards to enforce discipline.

How many women were put on board the Idahoe is unknown. The ship was built for 100 passengers. No reliable count was taken, and the best estimate is 150-200.

The journey to Louisville was a nightmare for Newcomb. His unwanted passengers destroyed the boat's once luxurious furnishings. He had to buy ice (for fevers) and food, at his own expense. Places where he stopped for supplies put guards at the dock to keep the women from disembarking.

The prostitutes continued to ply their trade, waving at men as they went upriver, and raising their dresses to advertise. Customers rowed themselves on board for brief stays as the Idahoe chugged slowly along.

By the time he got to Louisville on July 14, word of his unusual cargo had preceded him, and local authorities refused to allow him to disembark the ladies. Instead, he was ordered to proceed to Cincinnati. Kentucky's military governor assigned several soldiers to the Idahoe to serve as guards to help enforce discipline. This quickly failed, as the men given this coveted assignment received free services from the passengers.

By the time he got to Cincinnati, of course, the local government also refused to let him unload his passengers. Newport, Kentucky, on the other side of the river, didn't want the "frail sisterhood" (as the local newspaper called them), either.

So with nowhere to go, the Idahoe anchored off Cincinnati for several days, and turned a brisk business as a floating brothel while Captain Newcomb aged rapidly. Somehow he managed to persuade the army to telegraph Washington D.C. for a decision, and the question went all the way to U.S. Secretary of War (now called Secretary of Defense) Edwin Stanton.

Stanton was managing the complex issues of a war covering half a continent and an ocean, and was likely stunned by the unusual decision that showed up on his desk that day. He came up with a direct solution: Take them back to Nashville, and deal with it.

So on August 3rd the Idahoe returned to Nashville, and it's passengers resumed their usual lifestyle. This gave the headache back to the Union commander (now General Robert Granger) who spent a few days trying to find a solution, and finally came to a very pragmatic one: he legalized prostitution.

Under the new rules, each "public woman" had to have a license ($5) but needed to pass a medical examination first. She was then required to have another exam every 10 days in order to keep her license.

The solution was a success. Suddenly the "wayward women" had a legal profession. Disease control (by the standards of the time) improved. The prostitutes now had access to medical care that they didn't have previously. The Union doctors assigned to the "Hospital for the Reception of Valetudinarian Females from the Unhealthy Purlieus of Smokey" (yes, that really is what they called it) began taking notes, and wrote some of the first detailed reports on the sociology of prostitution.

The program was such a success that physicians from other cities came to study it.

Captain Newcomb spent the next 2 years trying to get reimbursed, meeting with military officials and eventually pleading his case in Washington. Finally, on October 19, 1865, he received payment of $5316.04. This was the amount he'd been asking for from the beginning for damages, new furniture, fuel, food and medicines purchased, etc.

He had a long career on the river, but never shook off the reputation as the "captain of the floating whorehouse".

He sold the Idahoe a few years later. In 1869 she was lost in the Washita River, cause unknown.

Skool Nerse Time

This is Mrs. Grumpy. Yes, another exciting school year has begun, and I'd like to share a short play with you.


Kid walks into my office today, doing some sort of weird I-can't-hold-still dance move.

Nurse Grumpy: "What's up?"

Little kid: "My butt itches!"

Nurse Grumpy: "Have you tried scratching it?"

Kid scratches ass for 10 seconds.

Little kid: "Thanks nurse, that feels much better." (leaves my office)

Thursday evening, 6:18 p.m.

Dr. Grumpy: "This is Dr. Grumpy. You called earlier?"

Mr. Husband: "Hi, doc. Hey, sorry my wife couldn't come to her appointment today. She's had such a bad migraine it's unbelievable. She's been so dizzy with it she can't drive or ride in a car. She can't even get out of bed."

Dr. Grumpy: "I'm sorry. Has it gotten any better this afternoon?"

Mr. Husband: "No, if anything it's worse. She's barely able to move."

Dr. Grumpy: "Can I talk to her?"

Mr. Husband: "Not right now. She's out in the yard climbing a tree, trying to get the cat down. Can she call you back when she's done?"

Anatomy 101

Yesterday I saw a guy who repeatedly mentioned that he's a nurse.

When he called he said he was having "carpal tunnel problems". That's fine, I can handle that.

But when he came in, all he wanted to talk about was his neck pain.

I can handle that, too. But I asked him why he'd said he was having carpal tunnel problems when he called.

He said "because the carpal tunnel is in the neck".

When I tried to correct him, he argued with me, then walked out. Said he was going to "find a doctor who knows his damn anatomy."

Who lives in a pineapple under the sea?

I'd like to thank my reader Linda for submitting this.

There are some things you never want to be stuck with.

Like finding out that you've been a habitat for SpongeBob Squarepants.

Or worse, that you're the one who left him there.

E-prescribing idiocy

I bitch about it. The Angry Pharmacist bitches about it. This is nothing new.


But yesterday afternoon I discovered a whole new reason to hate e-prescribing.


I have a lady who takes Fukitol 3mg, four times a day.

Fukitol only comes in 1mg pills. So she takes 3 pills, four times a day.

So 12 pills each day. OR 360 pills in 30 days.

HOWEVER, her insurance requires her to use Lostinthe Mail-Order pharmacy.

Like most mail-order pharmacies, this one only sends out 90 day pill supplies at a time.

So Mrs. Patient asked me to send it by e-script to Lostinthe Mail pharmacy.

12 pills x 90 days is 1080 pills. So I just transmit a script for 1080 pills.

Sounds easy, huh?

The online thing rejected the script, on the grounds that it won't allow pill supplies of more than 999 pills at a time.

I tried submitting it for 2 scripts of 540 pills each. It wouldn't allow 2 scripts of the exact same thing.

So I submitted it for 999 pills for 90 days, and figured Annie would just tell the patient the reason for this, and we could make up the difference with samples.

Of course, the online e-script program rejected this, too, and pointed out that a 90 supply for the patient is 1080 pills. It even asked me to resubmit it for that amount.

Which I did. And it was promptly rejected for being > 999 pills.

Catch-22.

I mailed a written script for 1080 pills to the patient and told her to send it to them. And scream.

Let's hope you aren't

Dr. Grumpy: "Does the hand pain wake you from sleeping?"

Mr. Carpal: "Sometimes."

Dr. Grumpy: "Does it bother you when you're driving?"

Mr. Carpal: "Why would I be driving while I'm sleeping?"

The joys of search engines

A doctor in my area died last week. Dr. Pissy and I were wondering what happened, so I typed his name into a search engine.

These were the first 3 links that came up:

1. Read the obituary for Dr. Unusualname.

2. Sign the online memorial book for Dr. Unusualname.

3. Make an appointment to see Dr. Unusualname.

Afternoon patient at Dr. Grumpy's

Mrs. Cuticle: "Harold! Stop chewing your fingernails! We're at the doctors!"

Mr. Cuticle: "Shut up! I'm hungry!"