Sunday, July 21, 2019

Happy Ice Cream Sunday!

On this National Ice Cream Day (the third Sunday in July), I present to you two portraits: one of me with chocolate ice cream in my face, and one with it on my face. This was the ridiculously large and unwieldy waffle cone I got at PNC Park after the rain delay Saturday night. It's got to be 5 scoops of ice cream: 2 in the cone and 3 placed precariously around the edges. Dear Husband got cookies N cream in a cake cone, which the server had the good sense to stack upright, given how quickly we had to lick them to keep ahead of the melting in 90+-degree heat.

Saturday, July 20, 2019

2019 Birthday Blast

This year our birthday celebrations lasted an entire week. The Saturday before, our respective parents drove into town for a meal of country-style ribs with homemade Asian peanut sauce (below), corn on the cob, green bean salad, and Dairy Queen ice cream cake--served on our best Mikasa china, of course. The next day Dear Husband played a splendid organ concert at St. Paul's Cathedral Church, and we celebrated some more with dinner at Alexander's Italian Bistro. The portions were so large that the two of us are still working our way through the leftovers.

His parents brought with them the "new" 2011 Buick Regal he had purchased from one of their neighbors a few weeks ago, as his old 2004 Chevy Malibu won't pass inspection this month.

On his actual birthday I had a little window in the afternoon to sneak away from the hospital for ice cream cones before finishing my notes and attending back-to-back dinner meetings.

On my birthday, I worked in both the hospital and the clinic, coming home in time for dinner. Then we cleaned up for a couple friends to come over to play Bananagrams and eat snacks.

Afterwards we opened cards and presents. We were blessed this year with many electronic and analog well-wishes. Our "haul" included a new suit for DH, a photograph of him in it for my future desk, another Pittsburgh Bits and Bites tour, a glass-mosaic flower pot, some lotion, and "mad money" that will probably go toward the cost of putting new tires on the Buick. The most unexpected and memorable gifts were original LIFE magazines from the months of our birthday, courtesy of out financial planner (?!).

Finally, Saturday I baked myself a strawberry cake with strawberry cream cheese frosting. Jenna over at Butternut Bakery convinced me to give up the (boxed) yellow cake with (dark) chocolate frosting and rainbow-colored sprinkles Birthday Cake I have had pretty much every year for as long as I can remember in favor of strawberry cake with strawberry cream cheese frosting. Although July is a little late for strawberries, this might have to become the new Birthday Cake. The cake itself is easy enough to make and comes out not particularly sweet. But the pink frosting has 3 (or 4!) cups of powdered sugar and covers up a multitude of sins, including one slightly burned edge. That's me pureeing strawberries while watching Fantastic Beasts and Where to Find Them: The Crimes of Grindelwald next to the recipe.

That night we had residency tickets to the Pirates vs the Phillies baseball game. On the way, we had to get around not one but two cars stopped in the middle of the road. The weather was SO. HOT: 104 with the heat index. It was too hot to sit outside, nevermind exert yourself playing baseball. There were a lot of doubles, and kudos to the pitcher who later came around and scored. I wondered if we could tolerate it for a whole 9 innings, when suddenly the ominous-looking clouds that had taken up residence above the stadium opened up. Rain delay! We hustled up the stairs from our second-row seats to the concourse. Soon it stopped long enough that we could join the line for ice cream. The temperature briefly dropped before the humidity really kicked in. In the bottom of the month inning there was some kerfuffle about a stolen base and a interference call, and the people sitting around us let the umpires know that the Pirates were going win anyway, and couldn't they just "play ball" do that the last out would put us all out of our misery?

Alas, the misery was prolonged by a concert letting out at the same time, and it took us an hour to get out of the parking garage, which was enough time to compose this post on my phone. However, we did come home with two bobblehead dolls, as the family next to us didn't need four of them.

Can you spot my new little flower pot with a drooping baby spider plant in it?

Sunday, July 14, 2019

What Residency Looks Like XLVI: beep BEEP BEEEEEEEEEEEEEEEEP!

Sometimes residency looks like being on call 24/14--as in, 24 hours a day, 7 days a week, for 2 weeks.

Sometimes residency looks like trying not to go stir-crazy by leaving the house at least once every day while also having to be ready to report to the hospital within 1 hour.

Sometimes residency looks like getting dressed every morning as if you were going to work--and stashing a pair of scrubs in the car, just in case.

Sometimes residency looks like the strange utilitarian calculus of trying to accomplish as many tasks as possible that would not be catastrophic if they were interrupted by a sudden call to come in to work a shift.

Sometimes residency looks like going to bed on time every night, because you know that the interns sign out at 6am, so you might be getting paged at 5am.

Sometimes residency looks like wrapping your pager in your towel on the side of the pool in case it goes off in the middle of swimming laps.

Sometimes residency looks like checking that your pager sound is on and the battery not dead because it hasn't gone off all weekend (no morning report or noon conference pages on Saturday or Sunday!).

Sometimes residency looks like letting your cat "hold" your pager, because you are so tired of having it on your person.

Sometimes residency looks like having the best first jeopardy that any of the chief residents can remember--because the one time another resident called off, you had clinic, so they asked the resident on second jeopardy to come in instead.


Saturday, July 6, 2019

Devastatingly Beautiful Memoir about Love, Intellect, and Disability

Image may contain: 2 people, people smiling, people sitting, table and indoor
Photo from A Life Beyond Reason's Facebook page. I do not own this image.

I have just finished Chris Gabbard's book, A Life Beyond Reason: A Father's Memoir (2019), and I am absolutely devastated. Gabbard describes the birth, life, and death of his son, August, and how August's impairments and disabilities changed Gabbard's outlook on everything from fatherhood to living with a disability to modern medical science to the Enlightenment to his belief in God (or initial lack thereof). While I found the writing somewhat thin at times--perhaps because it is intended for a general audience rather than literature professors such as himself--Gabbard tells August's tale, which begins and ends with medical malpractice, through his perspective as an atheist and an intellectual, with flashbacks to explain how he came to hold various beliefs. A birth injury, for which Chris and Ilene never successfully sued, left August with cerebral palsy and spastic quadriplegia. In his father's eyes this made August "monstrous" in the medieval sense of inspiring awe and (eventually) connection with the divine. In the eyes of many others, unfortunately,  it made him "monstrous" in the Enlightenment sense of defying nature, to the point at which some people could not bear to even look at August.

Perhaps most curious (or frustrating) to me as a medical provider and one who wants to work with the CP population is Gabbard's habit of not naming names--hospitals, doctors, and especially the medical device company that made the intrathecal baclofen pump that was promised to make everything easier but finally broke both August and his father's faith in medicine. I assume this was a legal recommendation. In addition, Gabbard spends a considerable part of this short and effective book rehashing the electronic fetal monitoring (EMF) of August's birth, which indicated fetal distress but was dismissed by overworked and/or overly optimistic birth attendants. But he never comes out and says that retrospective studies have shown that increased fetal monitoring has increased the rate of Cesarean sections to 33% of all births but has not changed rates of cerebral palsy (1:500 live births). Perhaps as much as 70% of CP comes from prenatal causes. Nevertheless, after two nonreassuring fetal stress tests, 39 hours of labor, and 12 days post-dates, maybe a Cesarean section would have prevented (more) damage. We will never know. It was more optimistic doctors (who may have had ulterior, career-minded reasons) who talked Chris and Ilene into implanting an intrathecal baclofen pump, although oral baclofen and Botox injections had not yet failed for August. Thus began his years-long death spiral of complications that ended abruptly with overwhelming pneumonia.

While Gabbard has grieved and will grieve for a lifetime over all this, I am still raw just from reading about it. What Gabbard wants us to know is that he is not sorry to have had the exquisite pleasure and pain of having been August's primary caregiver: waking him in the morning, bathing, changing diapers and clothes, hand-feeding, transferring from bed to floor to wheelchair to stander, and tucking him in at night. The two of them enjoyed each other, and August helped Gabbard realize that the high-intellectual tenets of his youth--namely Socrates' dictum that "an unexamined life is not worth living"--was a farce. Contra John Locke, the fact that August and Chris and Ilene and Clio and all the college students they hired as caregivers lived interdependent lives proved August's humanity. Along the way, Gabbard provides light disability theory and reviews a veritable who's-who of secondary literature on parenting a child with a disability and on modern medical practice.

I can recommend this book to a wide variety of readers, from curious laypersons to self-interested caregivers, and from pre-health-professional college students to practitioners in fields such as pediatrics, rehab medicine, and all the therapies.

Editor's Note: The book author is a colleague of an old friend from graduate school. I don't think this biases my judgment but does make me grateful I found out about the book so soon after publication!

Sunday, June 30, 2019

What Residency Looks Like XLV: Third-Year Bloopers

I've made a tradition of exposing my foibles with an annual blooper list: second year of residency, intern year, medical school parts 1 and 2. Here's the third year of residency, at least what I could remember to write down.

Top 10 Bloopers

10. The night shift I tried to save a disposable cup by using my travel mug with a drink machine and ended up splattering hot cocoa everywhere. It looked like I had violently murdered a chocolate Easter bunny.

9. The time I set my alarm for an extra weekend shift at 6:50am, figuring this would give me a good 40 minutes to wash, dress, pack a lunch, and enjoy some pancakes before heading to the hospital with plenty of time to spare. Except I was supposed to show up no later than 7:00am. Dear Husband happened to be getting up early for church, so he woke me up at 6:30am and then helped me throw some food in a lunchbox just in time for me to run out of of the house at 6:45am. Whelp! I wish I could say that was a lone incident, but two other times I picked up extra weekend shifts, only to lock myself out of the house at 6:30am, only to have to call Dear Husband to wake him up to come let me in to get something I had forgotten (like my car keys).

8. When I diagnosed pelvic inflammatory disease in a woman who had had a hysterectomy.

7. When I accidentally walked into a construction zone because just the day before a consult patient had been on that ward. Even though there was a sign hanging on the door "authorized personnel only." I am so used to being "authorized personnel" that I entered anyway. Oops.

6. The day I let my co-resident go home thirty minutes early at the end of our otherwise quiet night shift, only to be called to a C-section for an unstable baby, parents who wanted to refuse vitamin K, a cold baby, parents who wanted to refuse erythromycin eye ointment, a baby who needed to be transferred to another hospital and could I tell the parents, a baby who needed an ultrasound (at which point one of the on-coming nurses sniped that I should have made sure the baby was already in the triage area, although nobody had ever told me this was my job), and oh by the way, this other one's blood sugar is 29, and no one knows whether the mother is okay with bottle feeding.

5. The first time I trimmed a newborn baby's umbilical cord and splattered blood everywhere, including on the nurse who was helping me.

4. When a patient asked me to rewarm her homemade heating pad of rice in a sock in the microwave for 1:30. She didn't know the setting, so I did it on HIGH--which cooked the rice and burned two holes in the sock. Not only did the floor staff wonder what was burning, but when I returned to the workroom my nightshift colleagues could still smell the smoke on my scrubs.

3. The day I complained when I didn't hear about new admissions all day until the ED attending texted my attending that they hadn't been able to get ahold of me for hours...because I had forgotten to sign in my pager that morning.

2. That night in the adult emergency room when I did a rectal exam on a patient who was concerned that his partner had left a foreign object in the patient's rectum, and then he critiqued me on my technique: "That's why girls aren't allowed back there!"

1. Once while overseeing conscious sedation of a girl in the ED getting her broken arm casted under twilight sleep, I noticed that my vision was starting to black out. While it was uncomfortable to see her arm being manipulated to get both bones back in place, maybe I had locked my knees while leaning over the gurney, or I hadn't snacked enough that night. I told the attending physician, "Jenn, I'm feeling faint." She promptly took over the sedation, sat me in a chair while someone fetched cold OJ, and forbid me to do anything else. Afterwards the Orthopedics resident smugly asked, "First sedation?" "No," I replied. "Second."


Sunday, June 23, 2019

What Residency Looks Like XLIV: DANGER DANGER

Long-time blog-readers may be familiar with my obsession with toilet and bathroom technology. So of course I snapped a picture of this sign next to a commode at the hospital where I was moonlighting.


I could see the utility of posting such a warning in the janitor's closet, but why did they feel the need to tell the average toilet-user not to put their hand(s) in the toilet? Are toilet-induced hand injuries that common? If so, why have I never seen one in either the pediatric or the adult emergency room? The fact that somebody thought a sign was necessary suggests that these flesh-eating toilets are capable of inflicting the kind of the damage that would require an emergency room visit, rather than the kind that you swig a little alcohol, wrap in some gauze, and hope looks better in the morning.

Anyway, in case it needs to be said, keep your appendages out of the bathroom fixtures.


Tuesday, June 18, 2019

What Residency Looks Like XLIII: I'd watch that sitcom!

Two strangers become friends while undergoing the wacky hazing ritual that is a medical residency in the United States. Actually, there are two other trainee doctors in their cohort, but one has an evening ED shift and the other is working night shift. Typical that all four couldn't be together to celebrate the end of their third year together. Coming soon: third-year bloopers!