Wednesday, September 30, 2015

What Medical School Looks Like XXII

Sometimes medical school looks like me introducing myself as the Social Chair of the local American Medical Women's Association to a group of pre-med undergraduates, medical students, and doctors who gathered for dessert at the home of the director of the internal medicine residency. A good time was had by all!


Friday, September 25, 2015

Book review: Dangerous Pregnancies and the Threat of Disability

For the month of September, I was a visiting medical student in Madison, WI, as I tried to figure out what kind of training I should get to prepare me for my goal of working with kids and/or adults with disabilities. So I spent some time in hospitals and clinics; shadowing residents, physicians, and various kinds of therapists; and also some time reading, thinking, and talking about what it means to have a disability and what it means to care for individuals with disabilities and their families.

The first book on my reading list was Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America (2010), by my mentor and dissertation committee member, Leslie J. Reagan. Leslie has made a career studying the intersections of law and reproduction, having previously published a book about the criminalization of abortion in the19th century and its decriminalization in the 20th century, and currently researching Agent Orange and birth defects. Dangerous Pregnancies is a good and important book, because it tells the largely forgotten history of German measles as a driver of public debates about women’s reproductive rights and about (children’s) disability rights.
These days, German measles is probably better known as the “R” in MMR (Measles, Mumps, Rubella), but it was originally known by its German appellation, Rotheln. In children, the virus produces an illness like measles, but shorter, with lower fever and a faster, lighter rash. (Rot means “red” in German.) In pregnant women, however, the virus can cross the placenta, infecting the fetus and causing miscarriage, stillbirth, and/or numerous birth defects: blindness, deafness, heart defects, intellectual disability. Adults can catch it without even realizing they are sick.

At first doctors assumed rubella was a mild childhood disease (aka “3-day measles”), but in the 1940s, an ophthalmologist in Australia who saw several cases of congenital cataracts near a military base realized that the virus is teratogenic (causes birth defects). As this knowledge became more widespread, pregnant women who had been exposed through their children, while teaching Sunday School, or working as grocery store clerks started asking their physicians for (therapeutic) abortions. Leslie does an excellent job analyzing how these mothers-to-be viewed the situation as one in which they themselves (in consultation with family, friends, doctors, and religious leaders) had to make a serious decision about whether to end a pregnancy or take the risk of giving birth to a child who could have multiple, severe impairments that would take a heavy emotional and financial toll on the whole family.

You see, although terminating a pregnancy was technically illegal under the Comstock Laws*, the procedure was allowed in instances of rape or for the health or life of the mother. That loophole had been more and less enforced until the 1950s, when physicians and hospitals started regulating themselves. (This was either the moral thing to do or prevented more stringent outside regulation.) They set up medical review boards to judge each case individually. Rich and/or white women could still travel out of the country to secure an abortion, but poor women and/or women of color were often denied one. When a German measles epidemic swept through the United States in the mid-1960s, suddenly even married, middle-class, white women who had come into contact with rubella early in their pregnancies often found themselves without recourse to an abortion-for instance, if the local board were under the control of Catholic doctors who saw no reason to terminate a pregnancy, ever.

Popular media coverage and “wrongful information” or “wrongful birth” court cases described congenital rubella syndrome as “a tragedy” and the babies born with it as “damaged.” By the late 1960s, there was widespread popular support for legalizing abortion, or at least relaxing the rules. But first they became more strict: there developed a tenuous consensus that the procedure should only be performed to save the life of the mother—and German measles didn’t meet that criterion. On the heels of public and professional outrage that women ought to be permitted to make their own health decisions about carrying a (dangerous) pregnancy to term in consultation with their personal doctor, the Supreme Court ruled to legalize abortion in Roe v. Wade (1973) and Doe v. Bolton (1973).

By that time an effective vaccine had been developed (1969) and disseminated, in one of the most successful public health campaigns ever in this country. As Leslie explains, what made the rubella vaccine unique was that it was the first time individuals were encouraged to be vaccinated, not for their own health, but for the health of other people—namely pregnant women and future babies. The vaccine is intended to prevent the birth of individuals with multiple disabilities, but what to do about those who already exist(ed)? Dangerous Pregnancies concludes by opening a discussion into mothers’ efforts to secure an education for all their children, not just the neuro-typical ones, and the passage of the Education for All Handicapped Children Act (1975), now called the Individuals with Disabilities Education Act (1990).

Leslie writes some about the optimism and faith Americans had in science and the government in the mid-20th century: after the atomic end to World War II, after the discovery of numerous antibiotics and two polio vaccines, after a narrow miss with thalidomide, before the end of the Vietnam War, before Watergate. For a brief moment, Americans believed that the “tragedy” of a baby with multiple disabilities could be avoided. Of course it can’t. There is always a 1% risk of birth defects in any pregnancy, and the incidence of Autism Spectrum Disorders is now under 1 in 100. Those babies grow into children and adults who need a lot of care. I would like to be their doctor, and my time at the Central Wisconsin Center gave me valuable experiences with the high quality of care and life enjoyment that individuals with severe disabilities should get and can have.

[I would like to include here the photo I took of a music therapy session at CWC, during which residents and their aides played maracas, felt silky scarves, and spun around in their wheelchairs, but I don't have permission to share their faces on the internet. Just trust me when I say they were by turns stimulated and soothed. It was a joy to watch.]

*--True story: When I first read about Margaret Sanger and the Comstock Laws, probably in my first year of graduate school, I was so shocked that even writing about contraception had been outlawed, that I emailed my undergraduate mentor--the one I was visiting in Madison--and an older friend in graduate school, completely incredulous that in my 21 years, I had never heard of what came before Roe v. Wade.

Tuesday, September 15, 2015

What do a Sokol and a Bailador have in common?

While living in Madison for the month of September, I looked for a church. I found one at Sherman Avenue United Methodist Church. Sunday mornings, they have an early service in English and a later service in Hmong. The second week I attended there was a unified service for Multicultural Sunday. We sang and prayed in English, Spanish, and Hmong. Congregants were encouraged to dress up like their backgrounds. Afterward there was a potluck lunch with Mandarin, Vietnamese, German, Dominican, English, Norwegian, and Jamaican dishes. Needless to say, no one went hungry. After we had served ourselves, we were treated to a performance by the Ballet Folklorico Mexico Azteca dance troupe from Milwaukee. Easily a dozen groupings with as many costume changes danced a variety of "traditional" dances: a supposedly 1000-year-old Aztec ritual, Mexican polka and flamenco, and the Mexican hat dance. The dancers ranged from about 5 years old to 60? They reminded me of when we were kids, representing Sokol Baltimore and/or Czechoslovakia doing tumbling and pyramids at street fairs, malls, and cultural festivals.

Sunday, September 13, 2015

24 hours in Chicago, Part 2 of 2

After touring Frank Lloyd Wright’s home and studio (that post is here), Dear Husband and I walked around Oak Park in the lovely early fall weather. Unity Temple is still shrouded while undergoing extensive restoration, so DH suggested we come back in a year or two so that he can run the Chicago Marathon, and we can tour this other FLW gem. Of course I agreed! Lunch was at Eyrie, the Robert Morrison student restaurant, which was designed and is run by students. For a seasonal menu that changes monthly, the offerings are diverse, from soups and salads to flatbreads, entrĂ©e, and desserts. DH had steak, while I tried the Creamy Poblano and Potato Soup and a house salad with a subtle and delicious dressing.

Then we walked up to the Ernest Hemingway Museum in the Cultural Center, a rather amateur operation doing the best it can in a space that was not designed as a museum (it's a former church). The individual exhibits are mostly well done--staff are particularly proud of the antique doors used as cases--but their layout leaves something to be desired from an aesthetic and organizational angle.

We watched a 6-minute video about Ernest's high school years as well as an hour-long episode from a black-and-white BBC documentary about...what I'm not entirely sure; I put my head on DH's lap and fell asleep for part of it. Despite having read A Farewell to Arms about 15 years ago, I honestly didn't know anything about EM except the joke "Why did the chicken cross the road?" "To die. In the rain." It turns out he wrote poetry, too. 
Lives of great men all remind us
   We can make our lives sublime,
And, departing, leave behind us
   Footprints on the sands of time. 
Lives of football men remind us,
   We can dive and kick and slug,
And departing leave behind us,
   Hoof prints on another's mug. 
~From "A Psalm of Life" (191?). The first stanza is a quotation from Henry Wadsworth Longfellow's much more earnest "The Psalm of Life" (1838).

Nevertheless, I picked up the idea that Hemingway wanted to write about the world so clearly, so journalistically, that emotion would naturally follow in the reader. In fact, right out of high school he went to work for The Kansas City Star, whose style rules informed his writing: few adjectives, no extraneous words, active verbs, no passive voice, etc. In 1918, Hemingway signed up as an ambulance driver in Italy and was seriously wounded. He fell in love with Agnes von Kurowsky, a Red Cross nurse who was older than he; her breaking up with him became the basis for Farewell and for his future relationships. That he wanted to be the dumper rather than the dumpee may have had something to do with the fact that he was married four times. The gift shop--set up in what must once have been a coat closet--sells t-shirts with an arrow pointing up: "Ernest Hemingway's fifth wife."

The birth house is just up the street. A new doctor fresh out of training, Hemingway’s father Clarence Edward fell in love with Grace Hall, the daughter of the cutlery magnate living catty-corner from his parents. When her New York opera career under the bright stage lights clashed with her sight-loss from scarlet fever as a child, she took a European tour and then returned to Oak Park to marry, raise six children, and run a successful voice studio from her father’s house. (Her monthly income as a music teacher and performer was regularly several multiples of Dr. Ed’s.)

One of the things we learned was what American Queen Anne style looks like. Popular from 1880 to 1910, it involves an asymmetrical facade with a wrap-around porch, a tower, bay or oriel windows, front-facing gables, often with ornamented eaves, a wooden or slate roof, and decorative trim like painted balustrades (borrowed heavily from Wikipedia).

The first four Hemingway children were born in this house; the fifth at their Michigan summer cottage; and the sixth at the family’s second home. Young Ernest’s first brush with death came at age six with the death of his maternal grandfather, Abba, whose will decreed that his possessions be sold and the proceeds divided between Grace and her brother, by then a successful lawyer in LA. So the house was sold, and the family moved a couple blocks away.

We heard a lot of anecdotes about the house, like the breakfast table where Abba told the children stories, and about the traveling salesman uncle who lived with them when he wasn’t on the road, but DH and I had to learn later from Wikipedia that both suicide and (apparently) hemochromatosis both ran in the family. Hemingway's father shot himself at the age of 57 in 1928, depressed and worried about his finances. Ernest shot himself in 1961, just shy of his 62 birthday. He had a host of risk factors in addition to the family history: elderly white man with access to guns and two recent psychiatric hospitalizations for psychosis that included dozens of electroconvulsive therapy treatments. He may have been right to be suspicious: the FBI had been watching him for 15 years. Reportedly, he had found out he was also facing the same metabolic genetic disorder that his father had struggled with. 20 years later, his younger brother Leicester ended his life in the same way, after years of diabetes mellitus II and many surgeries. Ernest's sister Ursula and granddaughter Margaux sadly died of drug overdoses in 1966 and 1996, respectively.

I'll try end on a happier note.The photo on the left is one of my favorites. It's from Ernest's father's bedroom, which is decorated today with symbols of his profession as a physician; I didn't realize until later that DH is captured in the mirror, too. On the right is the house's one bathroom, with indoor plumbing; it demonstrates an intermediate phase in Victorian design: rich wood panels but porcelain fixtures and tile floor. The house tour was just right at about an hour long; although there was much more to see at the museum, I doubt we will come back, even though one paid admission is good for two visits in one calendar year.

"The Old Man & the Nazi Submarine Patrols."

There were a couple of these ironic revisions of classic EH titles; this was DH's favorite, as it references the time Hemingway spent during World War II patrolling the Caribbean in his personal fishing rig, since he was too old to enlist with the military again.

Saturday, September 12, 2015

24 hours in Chicago, Part 1 of 2

Halfway through my month away in Madison, I invited Dear Husband to meet me “halfway,” in Oak Park, so we could spend a day together. After fueling myself (with triple-chocolate Super Premium “Badger Blast” ice cream from the famous Babcock Hall Dairy Store) and the car (it had to settle for unleaded gasoline), I hit the road with all the other Friday evening rush-hour traffic. A long 2.5 hours later, I pulled into a parking lot in Westchester, a suburb of O’Hare International airport. DH had arrived that afternoon, having taken an Amtrak train, the Pink Line Metro, a CTA bus, and a mile-long hike back to the hotel after missing his stop. Dinner was Panera.

 The next morning after a leisurely breakfast that involved competing for the sole waffle-maker with half a dozen other guests, we checked out and headed to Oak Park. First stop: Frank Lloyd Wright’s Home and Studio, where I had purchased a photograph pass in addition to tour tickets. The original five-room house was completed in 1889, when the area was still largely prairie. It already has some elements of his later prairie style, like an off-set entrance, built-in furniture, and earth tones. In the entranceway you see nods to Greco-Roman art and culture in the form of a Venus de Milo statue and a bas-relief near the ceiling (left).

The central brick fireplace (right) can be enclosed to create “a room within a room”—but there are cut-outs on the short axes and near the ceiling to allow light, air, and sight-lines to pass through. I am a big fan of the window seats with their mint-green cushions (below).

The brick floor of the formal dining room (below) hints at its original purpose: as the house’s kitchen. The walls are covered by cloth and feature special windows. Check out the intricate wooden stencil covering the light fixture! If the house wasn’t originally wired for electricity, it was by the time FLW did the first remodeling in 1895. He pushed out the back and one side of the house, adding extra space on the ground and second floors.

Typical straight-backed wooden chairs in the dining room. Lovely custom windows in the recesses. 

Upstairs, FLW’s original studio was divided to allow the two girls to sleep on one side and two of the four boys on the other. Our tour guide Nikki explained that the barn-like interior in this part of the house harks back to FLW’s childhood growing up on a farm.

The master bedroom has been painstakingly restored, with FLW-designed furniture, gold stenciling, and stylized murals of Native Americans high on two walls. The doors and windows to what used to be a large balcony are supposed to form the shape of an open, unfolded kimono for a little Japonisme. (Appropriate ALL the cultures!) The tear-drop lights on chains are original, having been discovered during the remodeling.

The bathroom’s wide horizontal paneling reminds me of a cabin in the woods in Maine. Apparently the Wright children wished their bathroom had more fashionable (and hygienic!) tile.

Catherine’s room has one of the few original pieces of furniture in the house, the nineteenth-century cradle that rocked generations of Tobins and Wrights.

The children’s playroom with its high, arched ceiling makes up for the small size of their bedrooms. There are built-in cabinets and drawers, window recesses with beautiful stained glass, a small organ, and a baby grand piano. That’s just the keyboard you can see—FLW cut a hole in the wall and cantilevered the sound board over the spiral staircase behind! I didn’t get a photo, but there is a sign on it now that says “watch your head.”

In 1898, FLW added a much more architecturally daring studio to the property. You can see that already from the outside, with the "Atlas" figures on either side and several unique crane details made out of plaster and painted to look like bronze. The entrance way is hidden behind this portico.


The waiting room features my favorite stained glass, in the ceiling light fixture below, and a back wall painted gold. Apparently Wright thought he was important enough that he deserved a gold wall.

The studio itself is remarkable for the outside walls bearing all the weight of the multi-story structure, with the help of the chains you see (left). The octagonal library is an intimate space for reading or drawing up plans (right).

This is the second Frank Lloyd Wright tour we have taken; a few years ago we drove out to Taliesin while visiting Madison; and later we stopped by Fallingwater. We wanted to see Unity Temple during this trip, but it is currently shrouded for major renovations. Instead, we made pilgrimage to Ernest Hemingway's museum and birth house. Read about that here.   

Wednesday, September 9, 2015

What Med School Looks Like XXI

Sometimes med school looks like reading an article about the history of pediatrics while sitting on the edge of a lake--and trying not to get one's bum, papers, or electronics wet when the waves from a wake arrive! Many thanks to my attending for releasing me early on a beautiful late summer afternoon and suggesting this spot. That's downtown Madison way off on the horizon, across Lake Mendota.

This photo reminds me of another water-side scene, from last summer.


Sunday, September 6, 2015

Taste of Madison 2015

Editor's Note: Other posts you might like include reviews of Taste of Champaign and the Urbana Sweetcorn Festival.

Taste of Madison benefits area charities and non-profits, from local schools to a group that takes veterans fishing. They block off the streets around the capitol building for the stands, food trucks, and music stages. I biked down by myself and wandered around, looking for the best and most food for my twenty bucks. I wasn't really interested in the bands or beer, and having something approximating a well-rounded meal would be a nice bonus.

Hungry when I arrived, I stopped along the first arm of the square for a tamale from Ladonia Cafe, after another patron kindly offered to let me taste-test his. Then I had two free pieces of an organic granola bar (with chocolate, which is why I had stuffed the first one in my mouth already--it was still hot in early September, mind you).

Next on my menu was hand-battered fried Wisconsin cheese curds from Curd Girl, which had been voted Best of Taste 2014. Cheese curds are the first end-produce of making cheese, before the little bits get pressed together into a wheel or a block. They were hot and gooey, and when they were gone, I was done with them.

Along the next arm of the square I found a meat entree. When the dude behind the stand asked me if I wanted mustard, I retorted "Of course!" He laughed and agreed. The guy two in front of me in line got two ribs, which is what I was expecting, but I only got one. It was fine.

I passed up the ethnic foods on the third arm. On the fourth side I finally found my vegetable: roasted corn. No stick--instead, the husk was peeled down to make a handle. Needed more salt and butter. I wanted a sno-cone for drink/dessert, but the stand must have run out of supplies, because they were already packing up.

So I splurged on something that had been recommended to me: chocolate-covered cheesecake, turtle-style (with walnuts and caramel) from the Little Shop of Cheesecakes. It was a little messy to eat, because it had to melt enough that I could bite into it. As you might expect, it was very rich.

Biking back, I stopped at the lakeside beach just 5 minutes from where I was staying. I took off my shoes and waded a little in the water to take this selfie lookie back toward the isthmus and the food and music party that was ending.