GI CME

CME (Continuing Medical Education) is a necessary evil of the medical field. Like other professionals, we have to do 20-30 hours every year of BS courses to prove we're trying to keep up on our profession.

I personally try to do them online, but there are plenty of companies trying to make them interesting. One common way of doing this is to combine them with a vacation, such as a cruise. So CME-themed cruises are now a real thing for those who wish to rack up some education credits while seeing the world.

Some tie-ins are better than others, as evidenced by this brochure:

Just awesome, isn't it? Generally when you think of something "cruising through the digestive tract"... it probably isn't the S.S. Royal Princess (unless that's what you've nicknamed your butt plug).

I also love the use of the phrase "intimate atmosphere" on the same page as "gastrointestinal pathology." Putting a camera up someone's nether regions is about as intimate as you can get.

Given the history of cruise outbreaks, one can also imagine a boatload of doctors with Norwalk Virus "cruising through" their GI tracts.

Thank you, R!

Anatomy

This referral form came in last week. I'm going to hope it's just a handwriting issue.

Because if it isn't...

Gifts

I'll return to my regular posting schedule next week. Been crazy here. In the meantime, keep sending in those ideas for the holiday gift guide!

Let your fingers do the walking

Mary: "Can I help you?"

Mr. Amarillo: "Can I borrow your yellow pages?"

Mary: "Um... We actually don't have one. In fact, I can't remember the last time we had it around."

Mr. Amarillo: "How do you look up phone numbers?"

Mary: "I just use the internet."

Mr. Amarillo: "Oh, one of you people. I'm not into those fads. Does one of the offices around here have one?"

Mary: "I don't know, but I'm happy to look something up for you. What do you need?"

Mr. Amarillo: "How do you know any number you find on there is correct? I only trust the yellow pages."

Mary: "I'm sorry, but we don't have one. Why don't you let me..."

Mr. Amarillo: "I'll just try another office. I'm not into this stuff."

Decisions, decisions

Another challenging question in an online survey:

Thank you, TCH!

TNG

This is Craig Grumpy.

This past summer I worked at Drench & Drown water park's snackbar.

As you may have noticed, Coke had their promotion "Share a Coke with..." back in full swing again. This summer, instead of names like "Lucy" or "Ricky" the cans suggested you share a Coke with "your sweetheart" or "your better half" or "a favorite."

One afternoon Dick McJackass, the local high school delinquent, walked into the snack bar like he was walking onto a yacht, and bought a Coke. I grabbed the first one off the shelf, handed it to him, and moved on to the next person.

A few minutes later he was back. He shoved the person who I was serving out of the way, slammed the open can down on the counter, and began yelling.

Dick McJackass: "What is this?"

Craig: "Uh, it's the Coke you just bought."

Dick McJackass: "I KNOW THAT! Are you calling me a girl?"

Craig: "No, I'm helping this lady. You just bought a Coke."

Dick McJackass: "The can says 'Share a Coke with a Sis!' Do I look like a sis to you?"

Craig: "No. I just handed you the next can in the pack. It doesn't mean anything."

Dick McJackass: "Bullshit. I don't even have a sister. I want my money back, and a new Coke."

Craig: "I'm not allowed to do that. You already opened it."

Dick McJackass: "I want to talk to your boss."

Mr. Incharge: "I'm right over here, Dick. You can't have a new Coke or a refund. Get lost."

Dick McJackass: "Your counter help insults me and you support him treating a customer like that? You need to do something about that."

Mr. Incharge: "Okay. Let me see your pass for the day."

Dick McJackass: "Here."

Mr. Incharge: "Thanks. Get out of the park, your pass expired." (tears pass to shreds).

Dick McJackass: "You can't do that!"

Mr. Incharge: "I just did. You better call your mom for a ride home. If you don't, I will."

Dick didn't come back the rest of the Summer. It was awesome.

Christmakuh is right around the corner

So, if any of you guys have horrifying gift ideas you'd like to submit for this year's catalog, please send them in!

Summer Vacation, day 15

The last night of a cruise is always a pain. You have to put all your big luggage out in the hall by 10:00 so it can be moved ashore (otherwise you have to carry it yourself) and just keep what you need for the next day in a small bag. With 5 people, though, there IS no small bag.

I couldn't sleep, and stood out on deck in the early morning, watching as we sailed under the Golden Gate Bridge. I looked down at the sea, thinking of lives lost in the same waters.

The last day of a long cruise you're ready to be home. The endless buffets, the perennially busy ice cream stand by the pool, and the enormous selection of desserts... just don't look as good as they did a few days ago. You find yourself wanting something light and start to think about how you're going to fit in the clothes back home.

Your kids are up late with their new friends, exchanging emails and text numbers and Instagram accounts. In a week they'll have forgotten who they were.

And we were back in San Francisco.

Getting off the ship is a tedious process. Unless you want to carry all your own luggage off, you have to wait until they call your group. You have to be out of your cabin so the stewards can polish them up for the next occupants. So you end up hanging out in the buffet after breakfast... until the cleaning crew shows up to completely scrub it down before the next load of passengers boards.

You then move to a lounge, or hallway, anywhere... waiting for them to call your group for disembarkation. Mind you, we really weren't in a hurry, because we had several hours to kill until our flight out. But it's still boring as hell. Thank heavens for all the little modern gadgets of entertainment.

"Upon thy return, forget thee not to taketh thy firstborn's phone to the Apple store."

You want your dogs back.

It was a great trip. I'd say probably the most fun we'd ever had on a family vacation. But we were all glad to be home.

Especially Frank.

Summer vacation, day 14

Heading back to San Francisco.

We were woken this morning by Marie, frantically texting us from the kids' cabin next door. Craig had gone to get hot chocolate, and Frank, as usual, was passed out and unarousable. So she texted me.

They'd apparently gotten in late from the teen club, and she'd fallen asleep in her dress. While tossing and turning during the night, the dress had gotten wrapped around part of the metal bedframe, trapping her. And she really had to pee.

Unable to alert Frank, she used her phone to get help. I answered her the only way I could think of.

This morning, while scrolling through the day's activities on my phone, I saw this:

"I had no idea they had a Wiimote fleshlight attachment"

That sort of wording certainly gets your attention. Frank was horribly disappointed when he went to watch, only to find it was some octogenarians playing Wii tennis.


Someone was having a private party, and staff were wheeling trays of food from the kitchen to their suite. I saw this interesting item go by:

"Um, balls?"

I have to say, one really nice thing about this cruise line at dinner is that they don’t have the waiters doing a musical number every night. This is one of my pet peeves. If I want singing and dancing waitstaff, I’ll go to a restaurant that has them. But I don’t. So I’m glad that this line, unlike Carnival, doesn’t do that (NOTE: they did it on the very last night of the cruise, after I wrote this. But I can live with once).



After dinner, Mom, Frank, and I went to hold seats  for the evening's show. As we worked our way down a row the ship began rocking, and Mom grabbed the back of a chair to steady herself. To her horror there was a loud "CRACK" and the wooden decorative piece over the back of the chair came loose in her hand.

So there we were, with Mom (not knowing her own strength) holding the broken-off back of the chair and surprised people staring at us. She quickly set the back of the chair on the floor behind it and moved on, trying to act like nothing had happened. This wasn't easy, because as she did so "Amish Paradise" started blasting from Frank's back pocket.

"What's this on our room charges for a new theater chair?"

Summer Vacation, day 13

This afternoon they had a balloon drop in the ship's atrium.

They announced that some of the balloons would have prizes in them, so the floor under the net was packed with people ready to kill each other for whatever meaningless trinkets were in them. It looked like it could get ugly. It may be the only time some of these people would ever use the Ulu knives they'd just bought.

And, of course, the twins were down there somewhere, ready to kill for a cheap lanyard. I stood up on the 7th floor to watch.

After the appointed countdown, the free-for-all began. With balloons popped and the blood spilt, the twins were jumping up and down with something they'd managed to snag (I was sort of hoping it was Mrs. Bitchy's wallet).

They came running up the stairs with a rolled-up paper with a rubber band around it. Had we won a free cruise? A chance to drive the boat? Dinner at the deluxe restaurant? We carefully opened it.

It was a coupon for $15 off a $280 spa package.

Craig spilled my Diet Coke all over it. We left the mess there and went for ice cream.


Teenage boys are an interesting species to travel with, primarily for their ability to giggle and point out certain patterns they see

In nature:

 

Near the theater stage: 

 Even in the dining room breadbasket:

We got a starter of fried calamari tonight. I thought it was good, but Frank (at least he was brave enough to try it) didn’t like it, and spit it into his napkin.

There’s an old trick of hanging a spoon on the end of your nose, and for whatever reason, in the formal dining room tonight, my kids felt the need to practice it. The boys weren’t particularly successful, but Marie got it right. The trick ends when the spoon inevitably falls off... and in this case it went down the front of her dress and got caught in her bra.

Without thinking she pulled down her shirt to get it, exposing her developing cleavage to those around us. A kid at the Limoncello table stopped singing "Happy Groundhog Day" and yelled "TOM! LOOK!"

Craig, being a gentlemanly brother, graciously grabbed a napkin off the table to help cover her up. Unfortunately, it was Frank's napkin, and sent his hunk of chewed calamari flying down after the spoon. Marie screamed and jumped up, knocking her chair backwards with a crash. The spoon landed on the floor. The piece of masticated squid bounced onto the table. Craig spilled his water. Frank stood up as his phone started playing Amish Paradise. Marie, in frantically trying to pull her shirt back up, somehow unhooked her bra, and it fell down under her dress. She grabbed it off the floor and ran to the restroom, crashing into Parmesan-cheese-grater-guy.

Sigh.

There’s a line in the 1981 movie “The Four Seasons” where, following a fight between 2 men kicking a taxidermied moose head into a fireplace, Rita Moreno asks aloud “I wonder what other people do on their vacations?”

This is one of those moments that I ask the same thing.

Summer vacation, Day 12

Today, on the return leg south, we sailed into Victoria.

This is required by the Jones Act of 1920, which is still in effect. Basically, ships that aren't constructed or flagged in the U.S. (which is pretty much only 1 active cruise ship on Earth) have to stop in at least 1 non-U.S. port before returning to their point of departure.

Personally I have no problem with this, mainly because it means we get to visit either Prince Rupert or Victoria, both of which are lovely. Unfortunately, due to the distance back to San Francisco, the stop is only a few hours. So we caught a bus into town.

On the way in we passed a gift shop:

"Well, it does get your attention."

And a school:

"Hey, is that Cartman?"

And the ubiquitous A-word:

Wandering around we went through the venerable Empress Hotel, past parliament, and down to the water before heading back to the ship. The kids bought some crap and, of course, posed at the local curbside stuffed animal.

After dropping things off in the cabins, we went to lunch. Frank didn't show up, but I knew there'd been another late party in the teen lounge. I found him obtunded napping in the kids' room, where the steward had carefully set up Marie's stuffed animals.

"He has a pulse, and appears to be breathing."

And yes, that thing in the mirror really is a lava lamp. I know it's not uncommon to travel with a nightlight, but my kids insist on bringing a small lava lamp with them everywhere we go.



Each table in the dining room has 2 attendants, the waiter and the assistant waiter.

"Always two there are, a master and an apprentice."

 
The waiter is generally in charge of taking orders, making meal suggestions, bringing out the main course and dessert, chatting with you, and (for some) arguing about Ranch dressing. The assistant waiter is learning to be a waiter, and brings salads, clears dishes, keeps the bread basket and water glasses full, and other stuff.

This includes waving a pepper grinder over everything that’s put in front of you. Our assistant waiter clearly had no idea of what Americans do or don’t want pepper on, as he offered it to me over soup, salad, entrees, desserts, coffee, bread rolls, the butter tray... pretty much everything. If he wasn’t trying to pepper it, he was stalking me with a Parmesan grater. Due to his aggressive attempts to add flavoring, he became the only non-family member to spill the water. He was trying to pepper Marie's Bucket-O-Ranch when Frank's phone startled him by answering, and he bumped into the glass.

Leaving the dining room tonight, Marie handed me a mint (Grumpy's law: if someone offers you a breath mint, take it). To my surprise, the mints were Bipolar.

"Are they made with Lithium?"

Summer vacation, day 11

The cabins, like most, have a set of light switches by the door and another next to the bed. On this ship they were at the pillow level behind the bed, where they were easy to bump into. As a result it was not uncommon to stretch or roll over at 2:00 a.m. and suddenly be woken by all the lights to flip  on and blind you. This also caused the interesting phenomenon of walking by cabins of newlyweds and seeing a strobe light effect flickering under the door.


One nice thing about a cruise, if you're into this sort of thing, is that you never have to go too long without alcohol. Walking down to breakfast this sign greets you:

Now they actually have a plan where, for roughly $60 per day, you have unlimited access to alcohol. Not being much of an ethanol consumer, I'm perfectly happy with the $7/day all-you-can-chug Diet Coke card. Because I know I'm going to come out ahead on that one.


Today was the ship’s Egg Drop Challenge. This is something Marie cannot resist doing, so she signed up. The rules were pretty simple, though one in particular caught my eye:

"Wait, what does 'self-distructing' mean?"

Seriously? “Hey, Suzy's baby is chunky. Let’s duct tape the egg to him.”

Craig commented “You have to wonder how many people actually tried this before they decided to ban it.” Walking down to the contest I had images of someone tossing an Irish Setter with an egg strapped to it off the 7th floor balcony.

Some of these things were remarkably elaborate. One family had a shoe-box painted to look like a totem pole, and had attached "wings" on the side made of inflated rubber gloves they'd gotten from housekeeping. These people were SERIOUS. How serious? I'd noticed them testing this thing a few days ago by tossing it off the railing 2 floors above the aft pool.

Another team, lower tech, had taken a duffel bag filled with dirty clothes and stuck the egg in it.

Marie's gadget consisted of the egg surrounded by a proprietary mixture of shredded toilet paper and peanut butter, packed in the middle of 2 paper cups and wrapped with duct tape (yes she'd brought a roll of duct tape on the trip).

Her egg survived, but so did many others. So, when it was all over the winner was decided by having the audience applaud for whoever the cutest looking team was. Which inevitably ends up being either Golden Girl types or little kids. In this case it was the little kids who took home the water bottles.


After this high-stakes competition, I decided to go relax in the hot tub (you guys know how much I love hot tubs). Unfortunately, the ones in the adults-only “Sanctuary” area were full, and the mid-ship ones were full of small kids and the water was kind of yellowish. So I went out to the pair on the fantail. They were delightfully empty, with only a few people in each one.

I was in there about 15 minutes when I noticed the temperature around me was dropping. At first I thought we were sailing into a colder area, then realized they were draining the hot tub... with me in it.

The rest of the tub denizens noticed this about the same time I did, and we all dragged ourselves out. Not a crewman was in sight to bitch to, or ask “WTF ARE YOU DOING?,” or to have, say, warned us in advance that they were going to empty the tubs under us. Thanks, guys.


I went to a talk on Alaskan wildlife today. When they opened the floor for questions, one guy in a baseball cap with a fake dog turd on the brim asked "how old is a deer when it becomes a moose?"


Tonight, after dinner, our waiter brought me a coffee cup, and said, “be careful, the cup is very hot.” I thought he said “the coffee is hot” and couldn’t understand why the cup would be (actually, I still don’t understand that). So I picked up the cup to look in it, and, as advertised, the cup was PRETTY DAMN HOT. I dropped it back on the saucer with a loud CLANG, and the waiter looked at me with a “you’re a moron” gaze.

I don’t blame him, either.

Summer vacation, day 10

Today we were at sea.

As I walked through the atrium, the instrumental due were cranking out a medley of Queen’s greatest hits on accordion and violin. They were on “Fat Bottomed Girls” when I went by. It certainly summarizes the increased girth of all cruisers at this point, male and female. There’s an old joke in the industry that you board as a passenger and leave as cargo.


Toward noon I got my iPad to check in with the office. Running the immense Grumpy Neurological Emporium is a 24/7 job, even when I'm on vacation.

WiFi on board a cruise ship is NOT what you think it is. It’s more like slightly advanced dial-up. And they charge you for it. A LOT. Rates on board a cruise are usually 30 cents per minute and up, and it takes you a lot more time to do stuff than it does at home. And it frequently cuts out, requiring you to log back in. It's high on the list of shipboard frustrations. In spite of this, we still can't get Frank's phone to shut-up.


Tonight Craig ordered prawns for dinner. He likes shrimp, and since the waiter described prawns as “big shrimp” he thought that sounded just awesome.

The first sign that our dinner was about to go horribly wrong was when the waiter whisked the covering off Craig's plate, revealing the cooked prawns beneath. They looked nothing like the shrimp he’d expected. Craig screamed and jumped up in his chair, knocking over the guy with the pepper grinder, and began yelling “MOM! MOM! OH MY GOD MOM! THEY HAVE LEGS! OH MY GOD! LEGS! THEY HAVE EYES, TOO! MOMMMMMMMM!"

We were not anticipating this. AT ALL.

The family next to us stopped singing “Happy Whatever” and (briefly) set down their Limoncello.

Marie spilled her water.

Frank’s phone began playing “Amish Paradise.”

Our waited showed why he deserved a good tip. In a single motion he covered the plate up and removed it from the table, saying, “I will bring you a cheeseburger.” Craig was fine with that. Marie asked for more Ranch dressing.

They have what they call "movies under the stars." This means they put some flick on the poolside Jumbotron, and people can lay out on chairs and watch it.

This would be great... in the Caribbean. But at night at sea here the temps drop down into the 30's, and the wind blasts across the deck with enough strength to push your testicles into your chest (trust me on that one). So the deck chairs are empty, the movie is blasting, and 2 bored stewards are sitting there trying to hand coffee and blankets to anyone who might look vaguely interested in watching.

Because my kids are incapable of telling dirty clothes from clean ones, my wife went into their cabin tonight to collect laundry from the floor and stuff it in a suitcase. Unfortunately, this resulted in a frantic Craig beating down our door at 1:00 a.m. when he returned from teen club and immediately assumed the steward had, for unknown reasons, stolen their smelly clothes.

Summer vacation, day 9

Today we pulled into Ketchikan. The harbor was packed with ships, so much so that we had to anchor off shore and take the ship's boats to and from port. In these situations the boats are called tenders. In an emergency they're called lifeboats.

Because I'm a ship nerd, I had a lot of fun watching them set the whole thing up, swinging the boats out and lowering them into the water.

Yes, I know I'm pathetic

In Ketchikan it rains 364.7 days out of the year (365.7 in leap years) and true to form, it was raining heavily. A number of locals made the point that what we had today was just a light rain.

So we went ashore, where you learn all kinds of interesting things about Alaskan liquor laws:

Have another, Frank. We may not be back here until you can buy it yourself.

At the corner of the bar was a wooden beam. Because it stuck out under the railing it received a lot of rain, with the result that plants had taken root:

We walked around. Standing at this point I overhead one of the other tourists (Mr. Macho) say: "They have handicapped people here, too? I thought this was Alaska."

Because of the rain the stores had rolled their giant stuffed animal photo-stops inside, but this place had replaced theirs with a plastic one:

Pretend it's a stuffed moose, Marie.

Again, we wandered around the usual selection of stores selling Alaska shirts, hats, baseball caps, jackets, ulu knives, socks, wood carvings of moose, Burt’s Bees stuff, ulu knives, selfie sticks, picture frames, keychains, and ulu knives. I sort of just follow along, and pay the bills. I mean, it’s not like you expect one store is going to have anything different from another.

Here's some examples of what you can buy:

"Honey, do you think a Hog would fit in the suitcase?"

"Can't wait to wear this to singles night."

After wandering around for a while we went on a Duck tour. For those unfamiliar, it involves being driven around the city in an amphibious bus, which then drives into the bay and boats you around the harbor (in some cities they’re called Seal tours).

The tour immediately got off to a good start when we encountered our favorite leather purse... Mrs. Bitchy. She had a bag full of souvenir shit on the empty seat next to her, and refused to move it so my Mom could sit down. Even when told to do so by the skipper she refused, arguing that, by paying for a ticket, she was entitled to an extra seat for her packages. Eventually she ended up leaving the bus/boat and getting a refund, but not before flipping all of us the bird.

We passed this place:

"Screw you and your copyrighted name."

As we cruised around the harbor we went by a fish processing plant on the dock. The water around the building was covered in white froth, which our guide explained was “leftover liquefied fish parts.” I thought Craig was going to barf. Frank's phone said "I've found 17 fish restaurants nearby."

We passed what looked like a closed fast-food place... As it turned out that's exactly what it was. The guide explained that corporate IQ types, none of whom lived locally, thought a waterfront fast-food drive-thru would be a big hit. Failing to take local warnings into account, they built it. The problem was that the drive-thru was located where high waterfront winds can blast through at 50-70 mph and carry a lot of water with them, making it pretty damn hard to hear orders, pay for them, or hand over bags of food. So it was a remarkably short lived venture. After dealing with them in healthcare, it's nice to know the corporate types are equally stupid elsewhere.


Ketchikan is also where Alaska's only recipient (to date) of the U.S. Medal of Honor lived out his final years, retiring to a boat in the harbor. He served in WWII, Korea, and Vietnam.

Back on the ship that afternoon, they had a presentation by the chief engineer and his assistant on the engineering aspects of the ship. Being fascinated with this kind of thing, I showed up. Comically, there was a delay because neither of them could figure out how to work the slide projector. It got even better when the ship’s 2nd officer got lost on his way to give the “navigation at sea” talk.

My favorite question of the afternoon came after they explained how the ship distilled all it's own fresh water from sea water. Some guy stood up and said "how come they don't use this method in places like deserts, that are far from the sea?" The engineers looked at each other, pretended not to hear the question, and moved on.

Tonight at teen club they had a pick-up line contest. My boys, showing their remarkable skill at understanding girls, tried “Did you just fart? Because you blew me away.”