Saturday, December 31, 2016

Remembering the Good in 2016

Well, it's that time of year: time to unload my Rememberlutions Jar. Not only is having a place to store positive memories from the year a good habit to make, but the jar itself is a reminder of the years I spent studying and making friends in Grad Study at the Wesley Foundation in graduate and medical school. In 2015, I stored memories related to the last two years of medical school such as good grades and comments from preceptors, as well as experiences I had at the theater (fun, beautiful) or traveling (memorable, meaningful). 2016 included many more arts & culture moments, as well as big life changes. Here they are, in the order I pulled them out of the jar. Click the links for blog posts or websites.


The first slip I drew out was the note Dear Husband left me one night when he had gone off to choir practice before I had gotten home from the hospital.

Next was my PACE Palette score card from Pediatric Intern Retreat. Our class had gathered at Cheat Lake, WV, to learn more about ourselves and each other, such as the fact that I am the most analytical, curious person in the class but not as methodical or organized as I like to think I am. Later I posted what DH and I learned about our marriage that weekend.

Ticket to see "Mark Twain Tonight! Starring Hal Holbrook" at the end of April. I had bought us seats to surprise DH, but he spent the night in the hospital getting chemotherapy, so I took a mutual friend. Getting to see Hal Holbrook as Mark Twain is one of the many things cancer stole from him/us in 2016.

Invitation to K.T. and A.S.'s wedding in Knoxville, TN, also in April. My in-laws stayed with DH that weekend so I could get away and enjoy myself. Best of all, I got to stay with friends R. & M.K. on the way down and meet up with J.R. for the shindig.

Ticket to hear U.S. Supreme Court Justice Sonia Sotomayor with J.S. We were lucky enough to score extra press seats way up front. [March]

"My senior resident's delight the day I finished my progress notes before noon." He actually jumped up and hugged me. Unfortunately, the day ended on a sour note, as I got a late admission and ended up staying way after sign out.

"Matching to UPMC in Med Peds." [March]

"DH's 10th doctor-versary and my 2nd. 3/17/16." As luck would have it, we both defended our dissertations on March 17, eight years apart.

Ticket to watch The Grand Budapest Hotel at the Virginia Theater. That was late May, still in chemo season, and a friend came to stay with DH so I could leave the house without worrying about him.

"Snuggling in bed reading together (after laughing uproariously!)" [???]

Ticket to see the San Francisco Giants beat the Pittsburgh Pirates in June.

"O in Medicine and Society." I'm particularly pleased with the presentation I made on "Medicine on T.V."

Ticket to see the Miami Marlins beat the Pittsburgh Pirates in August.

Stickers that read "Delilah" and "Butch Cassidy" from a pre-show ice-breaker at a Wordplay performance at the Bricolage Theater. I found my "Samson," but DH never found his "Sundance Kid."

"The sky from the workroom on 12N. The first time the patient in 1260 smiled her toothless smile at me." She was a cantankerous, manipulative cirrhosis patient, and I had just combed her hair, about which she was very vain.

"Driving to my continuity clinic in Turtle Creek along the river and through the green."

Cover of the program for "Flight: Songs of Migration," a beautiful, moving performance by Amasong, the Lesbian/Feminist Chorus. DH was in the hospital the first time, so I went with A.S. to hear friend R. sing a solo.

"Bath time with DH." While undergoing chemo, he sometimes had a good hour in the evening, when I sat him in the tub (by candlelight when his eyes were sensitive) to bathe him.

Good, old-fashioned
collective action.
Ticket stub from Loving. [December]

Receipt from attending the Winter Flower Show and Light Garden at the Phipps Conservatory, a rare work-night date with DH after starting internship.

"O in Pulmonology."

"Found a woman's wedding ring outside the gym after the snow melted." I believe the staff were able to help me reunite it with her.

"Having D.W. for dinner and playing baseball Scrabble." He and I also took a daytrip to Covington to go antiquing one Saturday.

A sticker name tag from a residency applicant dinner. DH and I are suckers for free food and like the company, too.

Ticket to see Rogue One with my brother-in-law's family over Christmas 2016.

"Paid off the Turquoise Torpedo."

The cap off a bottle of Jones Soda that reads inside: "Your efforts will be well rewarded. Be patient."

"[The Pediatric Clerkship Director/My boss] complimented me on my TA leadership."

"Selling our house! 3/23/16"

"Fixed the toilet." Surely there's a line for that on a C.V.

Ticket to watch the Moscow Festival Ballet perform Don Quixote. That was back in January, and I honestly cannot remember a thing about it. I'd like to think I enjoyed it at the time.

Sweet mini-card from J.R. when she sent my Halloween earrings.

Ticket to Finding Dory, which we saw for my birthday this year. [July]

"Getting DH's scans back--times two!" This must be his negative CT and PET scans in August.

Another interview dinner name tag.

"Today I drove a metal spike into an old lady's spine with a hammer." ~The most audacious thing I did in medical school was perform a (supervised) kyphoplasty during my Pain Medicine rotation.

"Exchanging pickle phones with [the acting intern] to talk about our patients at just the right moment." We were fielding questions on each other's patients.

"Celebrating our Steel Anniversary in the Steel City." [August]

"O in Pain Management (Surgery II)."

Another note left by DH with dinner.

"Took apart and fixed the refrigerator/freezer."

"Walking in Frick Park."

"The trees and bushes heavy with snow as we drove to see Allegiance in the theater." [December]

Ticket to see Sinfonia da Camera perform The Mikado. [March]

Ticket to see "Opening Night," DH's last performance at the Virginia Theater with The Chorale. [New Year's Eve 2015]

Ticket stub from Sherlock, the holiday special that aired in theaters in January 2016.

And finally, tucked under the jar, my program for Back to the Future with Pittsburgh Symphony Orchestra playing the soundtrack. [July]


Not mentioned: Walking with CureSearch to raise money for pediatric cancer research (top left photo).

The love and support we got through DH's CaringBridge site while he was undergoing cancer treatment.

Oh yeah, and I graduated from medical school in 2016, too, but somehow between the family visiting, house packing, chemo, and celebrating, I forgot to put it on a slip of paper in my Rememberlutions Jar. (Instead, I've got a fancy piece of paper framed and hanging on our living room wall.)

Friday, December 23, 2016

The Wrong Cheesecake

Editor's note: Dear Husband and Frau Doktor Doctor have been reading and watching Sherlock Holmes stories together for the last two years. The opening of this piece is an homage to Sir Arthur Conan Doyle. While FDD may be recording an incident a la Dr. Watson, alas there is no real mystery for DH/Holmes to solve.

If you thought God had a sense
of humor when God created beetles,
wait til you get to the succulent room
Looking back over my notes, one episode from my intern year strikes me as a singular experience of teamwork tinged with humor and sticky fingers, what I think of as the saga of the wrong cheesecake. It was back in December of '16, when I was assigned to my third straight month of adult in-patient medicine. By then I was used to the rhythm of near-daily discharges and admissions, with a cap time that was the same as sign-out time. (For the uninitiated, that means that the day team had to admit any new patient who arrived on the floor before the hallowed hour of six o'clock in the evening.) Having discharged a patient in the afternoon on the first Friday of that rotation, we waited anxiously for the next one to arrive. Indeed, the senior resident had already received sign-out over the phone on a patient from the Emergency Department, but the minutes after five o'clock ticked by with no page from the floor clerk alerting us of his or her presence. The next intern with an open bed, I in particular was anxious, as I had planned an excursion with Dear Husband for that evening: dinner at the Phipps Botanical Garden and then a perambulation through their winter flower and lights show. Alas, the senior resident discovered from the ED board that the patient was being transported to the floor just in time! So he dashed to the nurses' station and pleaded with the clerk to hold the fateful page until after six, so that the night team would be the ones to admit the patient. She agreed but requested a favor in return--she wanted cheesecake. "Make sure you get her cheesecake!" my resident admonished. I gratefully agreed, signed out my patients to the night team, and went on my date. Inside the conservatory was crowded, and outside the temperature was frigid, but DH and I enjoyed the rare chance to spend two hours together doing something, anything.

The next morning I arose early, showered, and drove to the grocery store to fulfill the bargain with a four-piece sampler of cheesecake. I bought breakfast for the weekend team while I was at it. Once in the teamroom, I made a label for the gift out of red marker and scrap paper, "To the BEST clerk in the hospital." I even cut around the heart to make it extra fancy. I left it at the clerk's computer station. She came and found me during pre-rounds, introduced herself, and thanked me profusely. I considered the whole thing a success...

...until two weeks later, when my senior resident accosted me one afternoon: "You got cheesecake for the wrong clerk!"

"I'm sorry, what?"

It turned out there were two clerks on the floor, and they alternated Friday and Saturday shifts. I had thanked the wrong clerk. Abashed, I asked after the right clerk's schedule and vowed to make amends the coming Saturday. But that week DH and I had a full social calendar, and I had no time in the evening to go out of my way to the store. Friday evening I asked if DH could do our grocery shopping after I had gone to bed, so that I could bring the desired gift with me the next morning. He agreed, and I reminded him several times that I wanted "the one with four kinds of cheesecake," remembering the package in the cooler that had had four pieces of plain cheesecake. 

I quickly fell asleep, awoke the next morning--and found an entire, sixteen-piece "cheesecake" in the refrigerator. There were indeed four kinds of cheesecake, each represented with four slices. DH had done exactly what I had asked him, had he not? How had I forgotten to specify that I wanted the four-piece "sampler"? There was no way I could give the clerk that much cheesecake. It was too expensive and obviously out of proportion to her gesture of holding the admission page back for us. There was nothing to do but attempt to exchange it for a more modest offering.

Frantically, I threw together a quick breakfast, grabbed some tupperware as a back-up plan, and headed out the back door--right into freezing rain. The walkway behind our townhouse was a lake, just as our neighbors had promised it always was after heavy precipitation. I struggled up the sloping, icy street to my car, tucked the plastic bag with the cheesecake round by the back wheel, and set about breaking through the ice.

Dear Husband had mentioned earlier in the week his plan to keep his ice scraper in the house for just such an occasion, and I cursed my carelessness while using my key as a pick in the seal between the body of the car and the doors. I could not open the driver's door, but I was finally able to wrench the rear door open, crawl in far enough to grab the scraper, turn on the defrosters, and hit the button for the seat warmer. I also put the cheesecake in the back seat to dry off while I turned my attention to the windows and windshields.

When I remembered that the passenger-side windshield wiper had come off, I tugged on the door to retrieve the wiper from the floor for reassembly. It didn't budge. I went round and tried all the doors, but they were not stuck with ice, they were locked. When I had turned the key in the ignition, the car had automatically locked all the doors, with my keys, bookbag, and that damned cheesecake inside. I called DH from my cell phone, mercifully stuffed into my coat pocket. No answer. Twice.

Back down the icy street to the house I went, hopping on our neighbors' porches to avoid the puddle. I banged on the kitchen door--which he opened with some annoyance. I explained about locking my keys in the running car, so he fetched his own. Back up the street through the wintry mix, I left the wiper blade on the floor and drove slowly down the slope to our house, where I jammed on the parking brake, evaded the standing water twice more to return his keys to DH, and finally got in the driver's seat to drive to work. 

There was no question of being able to return the cheesecake now. I would have to make do with Plan B. Once in the workroom, I broke into the cheesecake and managed with insufficient grace to transfer three of the better looking pieces into the tupperware I had brought from home. I wrote another label--this time with the clerk's name on it--and ferried the gift down the hall to the nurses' station, where I presented it in person to the abashed but grateful clerk.

That left me with thirteen pieces of cheesecake, a dessert for which I have no particular fondness but will eat on occasion. I planned to fob some of it off on my teammates, but it was a Saturday, and the medical students were dismissed early. About four o'clock I went searching through my lunchbag for my daily apple, only to discover I had forgotten it in the hustle of the morning.

"I don't have my apple," I announced to my attending, who was working with us that quiet afternoon. "Do you know what this calls for?"

"Ice cream?" she asked.

"Cheesecake!" I replied.

"I like the way you think," she said, as I excused myself to the pantry, where I had stored what was left of the enormous round. 

After some awkward attempts with a napkin, I finally gave up, perched the entire plastic tray in front of my computer, and used a plastic fork to eat a piece of turtle cheesecake. 

"You weren't kidding!" the attending said, when she looked up. I agreed that I was not and offered her a piece, but she declined. The scene was similarly amusing to my co-intern, when he returned after seeing a patient, but he declined as well. 

So I ended up bringing twelve pieces of cheesecake home with me again. My last-minute attempts to invite friends and neighbors over for caroling (and cheesecake) were singularly unsuccessful, so the whole thing will be schlepped again to my in-laws, where I will offer it as Christmas dinner dessert.

Tuesday, December 20, 2016

What Internship Looks Like XXIV: Hospital Vistas 2

Sometimes internship looks like the stunning vista from a family lounge high up in a hospital tower. This is just the view toward the Allegheny River; there was more window and more landscape to the left. We used this room for end-of-life discussions, and occasionally for a quiet moment in natural light during the long, 12-hour days of our shifts.


Wednesday, December 14, 2016

What Internship Looks Like XXIII: Caring For the Patient

"For the secret of the care of the patient is in caring for the patient.”
~ Francis W. Peabody to Harvard medical students on October 21, 1925
If the secret is caring for the patient, the practicality is doing little things as a physician to minimize the big and small harms that patients suffer in our hospitals that have little to do with whatever chief complaint brought them to our attention. This was one of my favorite afternoon lessons while on wards, drawn by a physician-administrator who sees the iatrogenic morbidity statistics in our institution. The drawing reminds me of a "wound man," the early modern-era medical illustration technique in military medicine manuals that used one picture of a man with many different wounds to minimize the costs associated with creating and reproducing multiple illustrations. This one depicts delirium and falls that can come from a patient being sick in an unfamiliar environment; we should minimize overnight interruptions and tethers such as pulse oximeters, and make sure patients have their glasses, hearing aids, and dentures. Wearing a nasal cannula for supplemental oxygen can dry out their mucosa and cause nose bleeds. They can develop thrush or Clostridium difficile from antibiotics and mouth ulcers from chemotherapy. Being bedridden makes them susceptible to weakness, myopathy, deep vein thrombosis, and/or pulmonary embolism. The drugs we give them can have side effects like dry eyes/mouth, gastroparesis, and urinary retention. My attending was encouraging us to treat--to care for--the whole patient, not just their chief complaint.


Monday, December 12, 2016

What Internship Looks Like XXII: Accepting Help

Sometimes internship looks like the lunch your senior resident brings you when you're chained to your computer writing discharge summaries instead of attending noon conference.


Friday, December 9, 2016

What Internship Looks Like XXI: Teamwork

Shiny silver bow ties for the Platinum team: uncertain medical student, visionary senior resident, confident attending, gregarious intern, thoughtful medical student, side-kick co-intern.


Friday, December 2, 2016

What Internship Looks Like XX: Bathrooms, Take 2

Remember when I referred to a hospital bathroom with automated hand-washing/drying fixtures as "a germaphobe's worst nightmare"? Well, I found the next level of purgatory: 

You can observe the evolution of sanitary technology in this lady's room at a different hospital. The automatic sinks (with manual soap pumps) are to the right in the first photo (stalls behind). On the wall you see the big black paper-towel dispenser. But that's not very environmentally friendly, so 90 degrees to the left--next to the trash can--is a silver automatic hand dryer. The white leaf in the green cross announces that it is energy efficient. 

However, the door has to be pulled open inwards, or the automatic switch pressed, which would dirty one's hands again. So they mounted a small silver container for paper wipes you can use to touch the door handle (above). So we're back to paper waste again, because if the door could be pushed open outward with one's shoulder or hip, it would impede traffic in the busy hallway on the other side.

Nevertheless, if you look closely in the patterned tile "chair rail" in the second photograph, you can see a tiny black rectangle. That is the touch-free, motion-sensor door opener that allows one to wash and dry hands and escape the restroom with minimal contact with potentially contaminated surfaces. At last, the solution to the germaphobe's persistent question, "Are my hands clean after going to the bathroom?"