Wednesday, October 29, 2014


    * 1-1/4 cups milk
    * 1 cup all-purpose flour
    * 1 egg
    * 1 teaspoon cooking oil
    * 1/4 teaspoon baking powder

    * 1/4 teaspoon salt for savory crepes OR
    * 1 teaspoon vanilla + 1 teaspoon sugar for sweet crepes

   1.   Mix up batter as smooth as possible. Flavor as desired. (I made ours plain.)
   2.   Heat a lightly greased small skillet over medium-high heat. Remove from heat. Pour 3 tablespoons of batter into center of skillet. Lift and tilt skillet to spread batter and coat bottom of pan. Return to heat. Cook for a few minutes until light brown. Turn with a spatula, and cook second side until light brown and bubbly.
   3.   Slide finished crepes onto a warm plate. For filled crepes, spoon filling into center; roll or fold crepe while still in the pan; slide carefully onto plate. (Or just make a stack, as illustrated above, with the top crepe folded in half to reveal the filling.) Repeat with remaining batter, greasing skillet and stirring batter if needed. Makes about 12 (8-inch) or 16 (6-inch) crepes.

I can't remember where I found this basic crepe recipe, but I pull it out once a year for variety. I like to make a filling with goat ricotta cheese from our local farmers market--this one is herb and sun-dried tomato flavored. I added canned corn the first night (pictured above). The second night we ate this I extended the filling with chopped fresh broccoli. There is enough batter left for one more meal, but I'm going to have to improvise a filling. Suggestions welcome!

I paired the crepes with a raw kale salad massaged with lemon juice and dressed with 50/50 olive oil-lemon juice with a touch of honey and a generous amount of "hot" chili powder from Turkey. There is also cherry tomatoes, green pepper, and a white radish.

Tuesday, October 28, 2014

What Medical School Looks Like VIII

217. Sometimes medical school:
          a. looks like yet another multiple-choice question.
          b. tastes like kettle corn
          c. tastes like hot apple cider.
          d. sounds like electronica music.
          e. all of the above.


Thursday, October 23, 2014

Hug o' Tug o' War

"I will not play tug o' war.
I'd rather play hug o' war,
Where everyone hugs
Instead of tugs,
Where everyone giggles
And rolls on the rug,
Where everyone kisses,
And everyone grins,
And everyone cuddles,
And everyone wins."
~Shel Silverstein

Shel Silverstein was one of the preeminent poets of my childhood (along with Odgen Nach and Anonymous). This verse of his came to mind one night while lying in bed and thinking about my psychiatry patients: I want to hug so many of them. The outpatient encounters I have had so far were too brief to learn about many of the patients' hurts. In in-patient hospital medicine those hurts are usually physical. But in in-patient psychiatry, we spend enough time with them to learn about our patients' real wounds. If psychiatry has taught me anything, it is how cruel human beings can be to each other.

The standard psychiatric interview includes a history of the present illness, the patient's psychiatric history, and demographic information. That includes asking about any abuse or trauma the patient has suffered or is suffering. The stories of abuse and rape are horrific. So are the tales of woe about (near) homelessness, unemployment, lack of help caring for sick or disabled family members, missing disability checks, uninsurance (yes, still), toxic family dynamics, and lack of beds at substance-abuse treatment programs. It makes me want to hug my patients when they leave the ward, as if that could apply a thin layer of armor on them as they head back into unpromising situations without much of a social safety net.

Sometimes I want to hug them for joy, too. It is really gratifying to get a patient on a combination of medications that allows them to think clearly after months of agitation, racing thoughts, and frustration. One of them remarked to me, "Where have I been all this time?"

Of course, psychiatry is a particularly fraught field in medicine, unsure if it is more art or science. Do psychiatrists treat the mind or the brain? With the move toward more biochemical explanations of mental illnesses in the recent DSM-V, many of them feel that they can finally base their treatment plans on a materialistic pathophysiology that other doctors will respect. However, that further stigmatizes the disorders without neurotransmitter or genetic explanations as "all in your head." And not everything that is wrong with a patient can be treated with medication.

This tug-of-war between drugs and counseling is as old as psychiatry itself. Even after establishing psychoanalysis as an approach to mental illness, Sigmund Freud never entirely forgot his neuroscience roots. Tensions flared in the middle of the 20th century with the introduction of the first psychotropic drugs, which worked better than talk therapy for some conditions. "Better" at controlling patients and making them artificially compliant, retorted the likes of Thomas Szasz, who argued that without tests there could be few true mental illnesses. Patch Adams continues to advocate an extreme view of this line of thinking: out with the drugs that are overprescribed and just make Big Pharma rich, in with human connection and understanding. Forget haloperidol, hug your psychotic patient until he's calm.

I don't think I can cure any of my patients with an embrace if they ask for one. But it does seem like a positive human expression that cancels out just a little of their suffering. And who knows, maybe the endorphins it activates help their medication work better.

No Doctors Today, Thank You
~Ogden Nash
They tell me that euphoria is the feeling of feeling wonderful, well, today I feel euphorian,
Today I have the agility of a Greek god and the appetite of a Victorian.
Yes, today I may even go forth without my galoshes,
Today I am a swashbuckler, would anybody like me to buckle any swashes?
This is my euphorian day,
I will ring welkins and before anybody answers I will run away.
I will tame me a caribou
And bedeck it with marabou.
I will pen me my memoirs.
Ah youth, youth! What euphorian days them was!
I wasn't much of a hand for the boudoirs,
I was generally to be found where the food was.
Does anybody want any flotsam?
I've gotsam.
Does anybody want any jetsam?
I can getsam.
I can play chopsticks on the Wurlitzer,
I can speak Portuguese like a Berlitzer.
I can don or doff my shoes without tying or untying the laces because I am wearing moccasins,
And I practically know the difference between serums and antitoccasins.
Kind people, don't think me purse-proud, don't set me down as vainglorious,
I'm just a little euphorious.

p.s.--Beaucoup bonus points for anyone who can write a mental status exam on the speaker of this poem!

Saturday, October 11, 2014

Pick a Peck of Perfect Apples

It's a flying monkey in an apple tree! The only thing that's missing is a reference to the pumpkin patch.

One of the nice things about living "in the middle of a cornfield" is that farms are really close. Out at Curtis Orchard, little kids can visit the animals at the petting zoo, big kids can reach the apples in the trees, and folks of all sizes and ages can enjoy the yummy foods and drinks they produce: apple doughnuts, apple butter, apple cider, pumpkin pie...

One theme at Curtis Orchard is all things farm and fall. The other is The Wizard of Oz. If you can't read the sign under the shelf, it reminds you of the Guardian of the Emerald City Gates' declaration: "Nobody gets in to see the wizard, NOT NOBODY NOT NO HOW."

We went through the store first, to get A. a pick-your-own bag for apples, and to get me and Dear Husband doughnuts so we wouldn't starve before lunch. Next we hiked down the row of empire apple trees to the far end, where there were still some apples on boughs within reach, and back. Then we hiked out to the pumpkin patch. A. chose a warty pumpkin, while I opted for a round smooth one. 

Back at the country store, we paid for our pumpkins and picked up several gallons of apple cider and a jar of apple butter. Everything was deposited in the trunk. Then it was back to the Flying Monkey Cafe for lunch. The line was so long we waited half an hour just to order. Thank goodness it was all pretty much ready to go. A. and I each got bratwursts with sauerkraut; DH wanted the pulled-pork sandwich. My meal came with two sides: a broccoli salad with bacon and craisins dripping in mayo dressing, and a large slice of pumpkin bar with cream-cheese frosting that I saved for later.

While we waited, we watched the apple doughnuts being made. Stand mixers prep the batter, which a worker pours into the doughnut maker, on the left. It swings back and forth, plopping rings of batter into the hot vegetable oil. These are carried along by a paddlewheel to be fried and then dried. On the right you can see two doughnuts ready to drop over into the collection funnel. They sell glazed and cinnamon-sugar versions. (Mine was fluffy and light but lacking on topping.) I wonder how many hundreds they must make every day?!

Sunday, October 5, 2014

She's Got the Whole World in Her Hands

Today was World Communion Sunday in the United Methodist Church, when we celebrate how communion connects Christians through time and space. You may remember that last year, the creative worship committee RuacH outdid themselves in decorating the altar. That time I danced "Many the Gifts" with two other people.

This year, they decorated the altar with bread, grapes, and dolls from around the world: Thailand, Holland, Guatemala, Japan, Ukraine, and the United State. They asked me to "dance in" the globe during the introit at the start of the service. While the choir sang "Kum Ba Yah," I twirled and curtsied down the aisle, holding the globe by its astrolabe so that it spun with my momentum. Eventually I set it on the stand, gave it a spin, and danced my way out again.

In the middle above you can see my Czech Anna doll in a red skirt and black apron.

Left are parts of my costume. This morning I realized I hadn't given much thought to what to wear. However, earlier this year I inherited my paternal grandparents' Bohemian kroje (click for blog post). So I pulled them out, did a little mixing and matching, and asked friends on facebook to vote for their favorite. By popular consensus, I wrote the usual white leotard and long skirt, with a ribbon sash and a super fancy, beaded and buttoned red vest (back shown here). I also pinned the yellow ribbon over my ponytail.

Saturday, October 4, 2014

Tuskegee: All in the Name of "Treatment"

Nurse Eunice Verdell Rivers Laurie, ca. 1953
Nurse Eunice Rivers
(Click to see whole image.)
As predicted in the first (and until now only) post about my promise to read one book a month until I finish medical school, I have fallen off the bandwagon. In June I read with interest a trade book on Jean-Martin Charcot's three most famous female hysterics. One August weekend while traveling I read the most important chapters in Mary Poovey's Making a Social Body for editing my book manuscript, but I'll spare you the details, as it's highly theoretical. Then Disciple Bible Study started with Adam Hamilton's Making Sense of the Bible, and since Labor Day weekend we have read all of Genesis and most of Exodus. For September I am petitioning to get 1 book manuscript on which I am credited as "content consultant"; 2 articles on Natalie Zemon Davis's experimental and ground-breaking book The Return of Martin Guerre and the way historians marshal evidence; and 1 graduate colleague's dissertation chapter accepted in place of the month's "book." Then, despite my protests that I am already in the middle of three books (the Bible, Barbara Brown Taylor's Learning to Walk in the Dark, and MFK Fisher's The Gastronomical Me), Dear Husband tried to start Salmon Rushdie's Midnight's Children with me last night, but I insisted on hearing the introductory essay first because I know nothing about it except that it earned Rushdie a fatwa--and of course DH barely got two pages in before I was out like a light.

Photo courtesy of National Archives and Records Administration, Southeast Region, Morrow, GA
Some of the men in the Study.
(Click to see whole image.)
In July I finally got around to Susan Reverby's masterful Examining Tuskegee: The Infamous Syphilis Study and Its Legacy. To be honest, whether I read this particular book or the enormous, 600+-page volume Reverby had edited entitled Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study was 50/50. I had planned to pick up Tuskegee's Truths, figuring it would be good to be exposed to several different authors' perspectives on this important event in American medical history. In particular I wanted to read Vanessa Northington Gamble's chapter on African-Americans and medicine. But when I got to the library, I discovered TT was in the stacks while ET was available in the History Library, so I settled for the slimmer retrospective.

Examining Tuskegee provides a brief overview of the study itself, but that work has also been done by other historians. So Reverby focuses on the Study's legacy. Because "Tuskegee" has been maligned as everything that was wrong with 20th-century American medicine, she tries to walk the fine line between a historian's objectivity and an activist's outrage. Yes, the study was racist from start to finish, but not for the reasons you may have heard. (No one was purposefully infected with syphilis.) No, the study cannot be excused by "laxer" experimental standards of the time. No, it was not a secret. And because it produced no useful medical information, its questionable methods cannot be excused. This bad science continued for four decades out of a combination of inertia, misplaced paternalism, and the attempt to obtain some little data after all the years and expense.

Historical Photos of late 19th and early 20th century Macon County, Alabama.  Source is University Archives, Tuskegee University, Tuskegee, Alabama.
Late 19th- or early 20th-century
Macon County, Alabama.

(Click to see whole image.)
The study was originally designed to learn about the effects of untreated late latent syphilis in African-American men. (By definition, latent syphilis is not infectious and beyond the reach of penicillin.) The U.S. Public Health Service (PHS) researchers were particularly interested in black men because of a) the assumption that syphilis was common among them and b) the widespread scientific truism that they belonged to a more "corporeal" race and were more likely to develop cardiovascular complications (like inflammation of the aorta). White men by contrast were thought to be more "intellectual" and therefore more likely to develop neurological complications. However, this assumption was not tested, and white men in Macon County, Alabama, who wanted to join the study for its free "treatment" were turned away. Later, the PHS contradicted its own initial warrant and tried to generalize its results to all kinds of bodies infected with syphilis. Women were not enrolled "so that the question of congenital [syphilis] could be eliminated."

In 1932, mercury preparations were still the most common treatment for "the great pox." The PHS didn't have enough money to treat everyone, so it developed a study based on the inability to treat. Nevertheless, it lied to participants that they were being treated. In the 1940s, penicillin was discovered as a cure for syphilis. During World War II, the PHS actually prevented study participants from being called up to the US military so that they would not be diagnosed with syphilis and treated with penicillin. Stop and let that fact sink in for a moment. One arm of the US government that claimed to be helping its citizens prevented another arm of the government from actually helping. From the late 1940s to the early 1970s, many of the men did receive antibiotics from various sources for other infections. This is important for three reasons. 1) The PHS was evidently no longer providing a service (health care) that these poor, rural Alabamans could not otherwise obtain. 2) These drugs may have affected the course of their syphilis if they were not truly latent. 3) Therefore, the study results were bogus by its own definition ("untreated latent syphilis") in addition to being racist.

The Doctors
Blood draw.
(Click to see whole image.)
To their credit, the PHS did try to divert women and potential enrollees whom they diagnosed with active syphilis to treatment. But study workers did not always clarify to participants that they had been diagnosed with latent syphilis ("bad blood" could mean a lot of things, including merely fatigue at the end of winter, when fruits and vegetables were in short supply). They did not always diagnose the men properly, so their sexual partners and sometimes their children contracted the disease from them. Most importantly and paternalistically, they did not ask the men whether they wanted to donate their bodies to a scientific study. Rather, during life they were offered "therapeutic" spinal taps, aspirin, mercury salves, and "iron tonics." After their deaths, the PHS offered to pay the men's funeral costs if they would allow their bodies to be autopsied. Nurse Eunice Rivers also helped the men in other ways, much like a social worker.

Although the PHS knew that the African-American men of Macon County would not have participated in the Tuskegee Study if they had been told the truth, they still published more and less cleaned-up accounts in the medical literature of their work with these "volunteers." Now and again a scientist would write the study leaders to protest its racism and bad science, but it continued until an AP reporter broke the story in 1972. It quickly became a tale of  medical overreach sponsored by the government, of guinea pigs duped into dying for science, of "America's Nuremberg." Tuskegee contributed to contemporary discussions of consent and experimental design; President Clinton issued an official apology in 1997; and it remains a flashpoint for race and medicine four decades later. Of course it is much more complicated than that, but I think I have squeezed everything I can into this review. If you would like to know more, click on the image links in this post; they will take you to the website for Examining Tuskegee. Or, you could read the book!

We are four days into October, and because Psychiatry requires half as much studying as Internal Medicine did, I have decided to climb back on the bandwagon with a translation of Ute Daniel's The War from Within:German Working-Class Women in the First World War. Since my next exam falls exactly at the end of the month, I will have all weekend to write up my impressions. Watch this space!