Short visit

Seen in a chart:

Cancellation

Mary: "Hello, this is Mary from Dr. Grumpy's office. I wanted to confirm Mr. Lumbar's appointment tomorrow with Dr. Grumpy."

Mrs. Lumbar: "Oh, he won't be coming in. The back pain doesn't bother him anymore."

Mary: "Oh, okay, well I'm glad to hear that."

Mrs. Lumbar: "He's dead."

History reruns

May 7, 1915

Today in history, in a factoid well known to school children, the R.M.S. Lusitania was sunk by a German submarine with a loss of 1198 lives.

And... that little snippet is pretty much all most people know about the disaster.

The details are forgotten compared to her erstwhile competitor, Titanic. Nobody made a blockbuster movie about her. Plenty of books have been written, but they often focus on the debated aspects. Was the ship a legitimate target? Did the British admiralty intentionally put her in harm's way? Was she carrying priceless paintings? These questions will never be settled, and I won't debate them here.

Americans are taught that the sinking is what brought the U.S. into WWI. Horseshit. It certainly contributed, but was only a small part. In fact, President Wilson fought like hell to stay out afterwards, and the U.S. didn't enter the war for another 2 years. The resumption of unrestricted submarine warfare in 1917 was a bigger factor. And, although mostly forgotten now, the Zimmerman Telegram was likely the event that finally pushed America into hostilities. Except for those of you who (like me) are fascinated by history, you've probably never heard of it.

A voyage then was a far cry from cruising now. Today's ships are designed for entertainment, with shows, games, shopping malls, climbing walls, mini-golf courses, and countless activities. They're rarely at sea for more than 2-3 days (at most) and frequent port stops are part of the attraction.

That wasn't the case in 1915.

To get some idea of intercontinental travel in the pre-flight age, think of this: You were in a large hotel for 10-20 days. You couldn't leave. You didn't stop in port until the end. The restaurants, though opulent, were the same. Your fellow travelers, and the crew, never changed. The only entertainment provided by the ship were small orchestras for 1st and 2nd class, an exercise room, and a meager library. 3rd class slept in large dormitory-like rooms that doubled as their dining areas, and their only entertainment was whatever instruments and reading they'd brought. The North Atlantic crossing, arguably the busiest and most economically important of the era, was rainy, cold, and windy. The ships didn't have the stabilizing systems we take for granted today, and rolled with the choppy seas.

The Lusitania's stories are mostly forgotten (like the Empress of Ireland) probably because of the time scale involved. From start to finish the sinking took 18 minutes. In that sort of time, on a rapidly foundering ship, the overall reaction is rushed panic. The Titanic, in contrast, floated for 2 hours and 38 minutes after striking the iceberg. Enough time to avoid panic and for the norms of Edwardian society to dictate the events. Women and children first. Rich before poor. Americans & Britons before immigrants. Stories of the band playing to the end, of Isidor & Ida Straus choosing to die together rather than get in a lifeboat ahead of younger people, or the chief engineer who went back to carry out a crewman with a broken leg - with neither ever seen again. Thousands of stories in 158 minutes that immortalized the disaster.

In just 18 minutes, those on the Lusitania didn't have time to do much but try to get in a lifeboat. Most failed. Although (unlike the Titanic) she had enough lifeboats for all, the slope of the sinking hull, and the rivets holding it together, made it difficult to launch them. Many dumped people out before hitting the water.

But stories are there, you just have to look for them.

The Lusitania herself was a technological marvel. The first liner fitted with the revolutionary new steam turbines that today run everything from nuclear submarines to power plants. The first ship to have a central climate-control system (the ancestor of air-conditioning) to keep the interior at a steady 68°F, regardless of outside weather. The system also exchanged the air inside the ship 7 times every hour, eliminating the need to open portholes on a cold day. And, for a time, she was the fastest liner to ever cross the Atlantic.

On the antagonist in the tragedy, the submarine U-20, was a story. The ship had been identified as a large passenger liner, and Kapitanleütnant Walther Schwieger still had every intention of sinking her. He gave the order to fire, and it was the job of Quartermaster Voegele to relay it to the torpedo room.

But Voegele wouldn't. He told Schwieger he refused to carry out an order that would kill innocent civilians. Schwieger immediately relieved him of his post and had another officer do it. After returning to land, Voegele was court-martialed and spent the rest of the war in prison.

Very few stories are as popular, or been "re-booted" as much, as Peter Pan. From the Walt Disney cartoon, to Dustin Hoffman's "Hook," to 2003's "Neverland," the tale has been imagined and re-imagined, both in movies and theater, many times. And Tinkerbell now has her own spin-offs.

But the odds are you'd never have heard of Peter Pan or Tinkerbell if it weren't for a man named Charles Frohman. One of the leading theater producers of the era, he was instrumental in bringing the story to stage. First in London, then in America, he put J.M. Barrie's once obscure story in front of live audiences night after night. Frohman even had the title changed, from the original "Peter Pan - the Boy Who Hated Mothers" to the one you know: "The Boy Who Never Grew Up." It's as immortal as a tale can be.

Frohman died on the Lusitania, at age 58. Unable to jump into a lifeboat due to severe arthritis, and not knowing how to swim, he knew his life was coming to a close. He spent his last minutes with the wealthy Alfred Vanderbilt (age 37, also couldn't swim, and refused to get in a lifeboat ahead of women), tying life jackets to the nursery's baby baskets to make sure the infants would float. As the end approached Frohman turned to actress Rita Jolivet (who survived), and quoted from Peter Pan “Why fear death? It is the most beautiful adventure that life gives us." Then he disappeared under a surge of water.

As Margaret Mackworth and her friend Dorothy Connor watched the frantic rush for the lifeboats, Margaret commented that "I've always thought a shipwreck was a well-organized affair." Dorothy replied "so have I, but I've learned a devil of a lot in the last 5 minutes." An hour earlier, at lunch, Mackworth had told others at her table "It's been such a dull, dreary, stupid, trip. I can't help hoping that we get some sort of thrill going up the channel."

In Chicago, Illinois is Ambrose Plamondon Elementary School. Mr. Plamondon was a major American steel industrialist of the 19th century. When he died his son Charles took over the vast company... And, along with his wife, died on the Lusitania.

Another survivor who ran down to get her lifebelt remembered passing an open door, where inside a middle-aged woman cheerfully arranged and re-arranged her suitcase unconcernedly, as though they were about arrive in port.

In New York, Cunard's local director watched a crowd gather outside his office as news drifted in. He remembered watching a similar crowd outside the rival White Star Line office across the street 3 years earlier, hoping it would never happen to him.

The worst of human nature was on display that night through America, Ireland, and Britain. Mobs attacked and burned business and homes owned by families of German descent, or even those with vaguely German-sounding names.

To the people of Queenstown (now Cobh), Ireland, fell the rescue. As the first S.O.S. crackled from the Lusitania, local fisherman (who'd just come in to unload from the morning) frantically untied their boats and headed back out to sea to save as many as possible. It was a motley collection of mostly sailing boats, a few faster ones with engines, and even some that were being paddled. Boys standing on the cliffs of Kinsale to watch her pass saw the explosion, and helped spread the alarm to local life-saving patrols. The exhausted fishermen worked into the evening to save as many as they could.

As the 767 survivors came into town on overloaded boats, the townspeople rushed blankets and food to the docks. They found places to shelter the fortunate ones - in homes, hotels, warehouses... anywhere there was space - until Cunard was able to make arrangements.

To the locals also fell the unenviable job of handling bodies that were picked up by boats or washed ashore for the next several weeks. Those that could be identified were sent home, but many were beyond that. So three large mass graves, with coffins stacked 2-3 high (some with 2 children put in them) were dug at the Old Church Cemetery. More were buried in Kinsale, at the Church of St. Multose.

Some of the victim's names were known only to their families, sadly being listed on the roster just as "Mr. Stanton's manservant" or "Lady Adam's maid."

In 1912, as the Titanic was about to leave port, the suction from her powerful propellers pulled another liner, the S.S. New York, away from the dock. The 2 ships missed colliding by roughly 3 feet before tugboats could push them apart. Now, 3 years later, the New York was linked to another tragedy. The American government chartered her to bring citizens, living and dead, back to the states. She carried the bodies of Charles Frohman, the Plamondons, and many others.

Survivor Herbert Ehrhardt took off his shoes and gave them to a shivering man in his lifeboat while awaiting rescue. They didn't quite fit, but the man said they'd do. The next day Ehrhardt (and many others) went to a Queenstown shoe store to replace them. As he waited to be helped, he noticed his original pair lying discarded on the floor. He laced them back on and left.

U-20, the submarine that sank Lusitania, ran aground off Denmark in November, 1916, and was subsequently demolished. What's left is roughly 1200 feet from shore, under sediment. The conning tower was removed and is at a local museum.

Captain William Turner of the Lusitania survived the sinking when a wave washed him off the bridge. He was pulled from the water, unconscious, by the crew of a fishing boat. Although exonerated by the inquiry, public opinion held him to be at fault for not taking preventative measures. His wife and sons left him, and he never saw them again. He was assigned to command the ship Ivernia in 1917, which was sunk in the Mediterranean by a submarine. He survived again, but never returned to sea and died in 1933.

Kapitanleütnant Walther Schwieger was killed in September, 1917, when his next submarine struck a British mine.

The last survivor of the Lusitania, Audrey Lawson-Johnston, died at age 95 in 2011.

The once-beautiful Lusitania lies, collapsed on her starboard side, in 300 feet of water off Ireland. While the bow section of the Titanic still evokes a sense of grace and majesty, the Lusitania is little more than a large scrapyard. Her much shallower depth makes her susceptible to the effects of tide, weather, and temperatures. The attack by U-20 was also just the beginning. Countless times in WW1 and WW2 there was concern U-boats were using the wreck to hide, and so it was aggressively depth-charged by destroyers to scare them off.

The hundreds in the mass graves, whose identities will never be known and whose families never saw them again, are marked at the Old Church Cemetery by a single large stone.

Quote of the day

"I was in the ER last weekend for a seizure. They said my Dilantin level was 8. Or maybe it was 18, or 28. I don't know, it was a number with an '8' in it. Does that help?"

Anatomy

Garlic, like a lot of old dogs, is covered with random lumps, bumps, and warts.

This past weekend Craig was having a party (actually, Craig seems to have a party every weekend, but that's another post).

As usual, Garlic and Onion were making the rounds, hoping to snag a pretzel or fallen cocktail weenie. At one point one of Craig's entourage groupies harem friends began petting Garlic, so he hopped up on the couch next to her to keep the attention coming.

A few minutes later she noticed me wandering out of my office to get a Diet Coke and came over to ask...

"Hi, uh, Mr. Craig's dad. How come your dog has nipples growing out of his back?"

Check out

I was on call for the weekend, so Sunday night had the usual check-out call with Dr. Cortex:


Dr. Cortex: "Hello?"

Dr. Grumpy: "Hi, it's Grumpy."

Dr. Cortex: "Okay, let me get my list and a pen..."

Dr. Grumpy: "How was your weekend? You guys do anything?"

Dr. Cortex: "We took the grandkids to the annual air-show, but, one of the planes crashed while landing. They said the pilot was killed and the passenger badly injured. Fortunately, we were at the snack bar when it happened, so Billy and Dolly didn't see it. But it must have been horrible. We left right away."

Dr. Grumpy: "I don't blame you."

Dr. Cortex: "All right, I'm ready for the list. What have you got for me?"

Dr. Grumpy: "Okay. In the ICU, room 37, is a guy with a serious head injury. He was a passenger in a plane at the air show......."

Thud

Dr. Grumpy: "Did you have those labs done?"

Mr. Siphonaptera: "Hell no. I walked out of the lab. They treated me like crap."

Dr. Grumpy: "What happened?"

Mr. Siphonaptera: "The girl at the front desk told me she was going to have me see a phlebotomist, which is bullshit. I don't have fleas. So I left."

11:38 p.m.

Dr. Grumpy: "This is Dr. Grumpy, returning a page."

Ms. Papaveraceae: "Hi, I'm a patient of Dr. Brain's, and I ran out of Percocet. My pharmacy number is..."

Dr. Grumpy: "I'm sorry, but I don't call in controlled drugs after hours. You'll have to contact Dr. Brain's office on Monday."

Ms. Papaveraceae: "But I really need it!"

Dr. Grumpy: "I can't call in any narcotics. What I can call in is..."

Ms. Papaveraceae: "But I can't take anything else because of religious reasons. I belong to a small sect that worships poppy flowers, so..."

Dr. Grumpy: "I'm not calling narcotics in."

Ms. Papveraceae: "So you're discriminating against me on the basis of my religion? I will get an attorney and..."

Dr. Grumpy: "Have a good night."

Click.

Relevant

Last week I received a letter from a research company, looking for "experts in a specific field."

It asked if I could answer "yes" to any of the following questions:

In Memoriam

 
My kids have now passed one of the milestones of modern adolescence.

The death of your first car.

The boys aren't having much of an issue with this, but Marie is taking it vary hard. The 4Runner was her baby.

You may remember her adventures with the car, when she outraced her older brothers to be the first with a license. The Toyota was 19 years old, with 265,000 miles, but she loved it. For reasons known only to her she named it "Dakota," which she insisted on spelling "decoda."

And, fittingly, it died with her at the wheel.

Rolling down the freeway on her way to an off-campus class, it suddenly began shaking wildly under her and making a racing noise. Alarmed, she took her foot off the gas and started to pull into the emergency lane. Then there was a loud "BANG!"

The engine stopped, never to turn again. As she came to a halt, Marie noticed a lot of fluid and some pieces of metal in the road behind her.

Since nothing fazes Marie, she calmly called AAA to arrange a tow, only bothering to notify her parents of this change in events when AAA asked where they should haul the car.

The next morning the guy at the car place asked if I could swing by on the way to work. Taking me into the garage, he showed me a jagged hole in the engine block the size of a football. As I marveled at it he handed me a chunk of metal that used to be piston, and pointed out where he'd found it embedded in the undercarriage.

I thought it looked like a femur. Keys are for size comparison.

So, after circling the globe 10.5 times, the car is being donated to charity.

We went to the repair shop before it was towed away to strip it of our personal stuff. This included $5.82 in coins scattered in cup holders, seat cushions, and under floor mats.

Marie carefully pried the 4Runner nameplate off the back, and it's now hanging in her bedroom, next to the hunk of piston.

I'd have to agree

I'd just finished doing an EMG/NCV on a patient.


Dr. Grumpy: "I hope that wasn't too bad."

Mr. Needle: "Nah, it went fine."

Dr. Grumpy: "Good."

Mr. Needle: "Yesterday they stuck a camera up my dick. That was much worse."

Seen in a chart.

If this MRI finding is correct, it's a publishable case.

 

My readers write

I'd like to thank the person who sent in this allergy list:

"Really? I have more trouble with their teeth and claws myself."

You don't know jack

NOTE: the following is NOT an April Fool's Day joke.

I'd like to thank the Science Marches On Department for sending me a truly remarkable piece of research.

Scheduling in a medical clinic requires talent, skill, and magic. There's only so much time in a day, and a lot of patients who need to be seen. People often portray the front-desk wizards as brainless, but they're far from it. Mary, after 14 years, knows me and my patients. From a few seconds on the phone she can get a good idea of how much time any particular patient will need, how that meshes in with the rest of my schedule, and (based on history) how long I am with any given return.

She also has to figure in how long it take takes me to grab a Diet Coke and drain a previous one between visits.

Any practice faces this issue, so obviously some research goes into improving work flow.

A study out of Miami, Florida recently looked into this important subject to calculate times needed for appointments at a fertility clinic.

Specifically, how long it took for a guy to, uh, shake hands with the milkman.

Yes, they wanted to know. That.

In the study guys were given a donation cup and unnamed porn mag. A stopwatch was started at the time they entered the room. They then took matters into their own hands, and texted "done" to the stopwatch person after the research project had climaxed.

For privacy, the exam room had a curtain. Boy, that's a relief.

Admittedly, it sure beats the idea of having a burly orderly with a timer in there, watching you box the one-eyed champ, but still.

The study makes no mention if the guys were allowed to wash their hands before picking up their phones to text the desk afterwards.

This graph is, by far, the best part of the article. It shows how long a guy takes to let it fly while pumping gas vs. the number of patients seen that day.

Note the blue bars: some guys actually had their ladies in the room during the process, although, under the fertility protocols, they weren't allowed to have physical contact. So the bottom line is that, if someone is watching you polish the banister, it will take longer to finish the job. In fact, the ONLY guy in the study who was unable to successfully finish marching the penguin was one who had his girlfriend in there.

Who could have seen that coming?

You can read the study itself here. It has pictures of the exam room, and a porn mag with a brown paper cover on it.

Thank you SMOD!