Oh, here's the place for the old "blowing smoke up your arse" medical reference.
Living in the land of 10,000+ lakes, I was thinking the second configuration was maybe for smoking while snorkeling. Not having such a pipe myself, I'm thinking of maybe a redesign of my favorite snorkel.
Or maybe submarining: "Up pipe-a-scope." (Show the bowl. Is there a lens with crosshairs in it?)
As for the guy in the photo, notice the pipe isn't lit yet? Maybe he's just finished a Blooming Onion from Outback on his own. Explains the belch, the breath AND the state of disarray.