Wednesday, September 13, 2017

What Residency Looks Like IV: Sunshine

Sometimes residency looks like sunlight and shadows in the hospital healing garden. My attending likes to give her teams a break once a week, so I am AWL (absent with leave) from the ICU, enjoying fresh air and the giddy feeling of being outside in the middle of a work day.


Thursday, September 7, 2017

What Residency Looks Like III: Bees and Flowers

Sometimes residency looks like an outdoor snack break in the middle of a computerized exam to clear your mind and process the death of one of your clinic patients.


Monday, September 4, 2017

Columbus: So Much Topiary!

For years now we have celebrated our anniversary with a quick trip to a local city to recreate our honeymoon. We originally spent 5 days in Denver and Estes Park, seeing the botanical garden, the art museum (I bought us t-shirts: DAM that’s great art!), and a baseball game. In Estes we hiked up a small mountain to a little lake, where a chipmunk ate out of my hand. Then we flew to Cleveland, where we picked up Michael’s car from the airport where his parents had left it for us and drove all night to get to Champaign-Urbana to move into our new apartment together. The next year we went to Chicago, then to St. Louis and Kansas City, Indianapolis, Milwaukee, Cincinnati, Madison, and Metropolis, IL. The year I got back from researching in Germany I didn’t want to see another suitcase, so we stayed home and enjoyed each other’s company in our own zipcode. One year we counted an April jaunt to San Francisco as “the trip,” and another year The Chorale’s big tour of Central Europe to Budapest, Vienna, and Prague. I wanted to sail in the Greek islands for our 10th anniversary, but the timing was poor what with me getting ready to travel all over the US for residency interviews, so we saved up for The Chorale’s next tour, of Spain and Portugal. Then Dear Husband got sick last year. We moved to Pittsburgh and counted our blessings to have each other, as we celebrated our 11th, "steel anniversary" in the Steel City

This year we celebrated with a fancy dinner on Mount Washington. Then, because I was off on Labor Day, so we decided to drive 3.5 hours to the other side of Columbus for DH’s family picnic after church. The weather only got nicer the farther west we drove from the remnants of Harvey. We had a delightful party, complete with corn hole (“bags”), kids having a water fights, and throwing a baseball around. Then we hopped in the car and headed into Columbus to the Comfort Inn in the German Village neighborhood, we had a lazy night watching Daniel Craig fall in love and get his heart broken in Casino Royale and then slept in until the end-of-breakfast rush at 9am. I was disappointed that the German Village visitor center wasn’t open the next day to tell us about the brick streets and houses, so we checked out and headed to the Kelton House, a Victorian mansion that was also a stop on the Underground Railroad. Alas, all my online research had not disclosed the fact that this museum is closed on Labor Day. Also the James Thurber House and the Columbus Art Museum.

Plan B: So we took a stroll through the Old Deaf School Topiary Garden, which uses shaped yew trees to re-create the 54 human figures, 8 boats, 3 dogs, 1 monkey, and 1 cat in Georges Seurat’s post-Impressionist painting A Sunday Afternoon on the Isle of La Grand Jatte (1884). The large photo above is from the painter's perspective marker on a little hillock; the one below is a close-up of one of the boats.

Then we ate some raspberry pie in the car, and set out for the second stop on our tour, the Franklin Park Conservatory and Botanical Gardens, which had the good sense to make their employees work on Labor Day (ha!), as the parking lot and grounds were full of people out to enjoy nature. First we ogled the Dale Chihuly pieces downstairs. Then we went upstairs to find the butterflies in the South Conservatory—an appropriately tropical South Pacific room. We were just in time to watch a staffer release a batch of new young butterflies. DH’s favorite was the large black one with brilliant blue wings; it had a wingspan at least the size of one of his hands.  

After the presentation, we hurried out of the heat and humidity of the tropics…into Himalayan and American deserts. The lower level concourse was blissfully cool, and full of hands-on activities for the young and young at heart: a coloring station, a large 3-D puzzle, and this train set up. That Thomas the Tank Engine rushing in from stage right, pulling Snoopy and the dog house; on the upper track you can glimpse the orange butterfly caboose.

One of the temporary attractions this season is topiary of endangered animals, which we encountered in the various rooms and gardens, like the lion above. Then we found chairs out in the workshop, just in time for the last glass-blowing demonstration of the day. An artist narrated as she created a red flower vase; there were a variety of specimens for sale in the gift shop. That was pretty cool. There was more Chihuly glass art, of course.

Upstairs were a collection of Bonsai, many of which were at least as old as I am. This conservatory is about the size of the Phipps, but I found the signage inadequate for really learning about the plants. It is however well set up for hosting events, as long as your guests don’t find baking in the greenhouses. Maybe it’s colder at night. After two hours we had seen everything and repaired to the car for apples to tide us over until we could get to Wheeling, WV, for pizza and salad dinner. Although we did not see everything I had planned on this short trip, it was restful, which is the most important thing, and we got home in good time for me to go to bed early in advance of three weeks of 4AM wakeups.

At 3 hours from Pittsburgh, Columbus is not a bad drive away for a weekend jaunt. My impression of the city is of wide streets with little traffic. There's clearly plenty more to see and do, such as a prize-winning zoo. I expect we'll come back to get a better taste of Ohio's capital city.

Friday, August 25, 2017

That's So Pittsburgh: Summer Fridays at the Frick

Third time's a charm: we finally made it to Summer Fridays at the Frick. The first time we tried to go, it started raining as soon as we walked out of the house. The second time I wanted to hear a friend play with his band, but I had worked a night shift and ended up sleeping the day and evening away. This was probably our last chance to attend, so we packed up some wine, pizzelles from the Bloomfield Little Italy Days, and our old lawn chairs that suffered more from the mice in our old garage than we ever used them and walked over to the Frick mansion. We passed up the food trucks selling burgers, pizza, tacos, and ice cream and set up on the edge of the big lawn, where families and couples were picnicking. Although the band was set up on the adjacent lawn, they were loud enough to hear but not so loud that we couldn't think or talk. I found it mete that the performers were a rock band called The Optimists. If we had not gotten cold--the temperature was only 70 when the sun was up--we might have visited the Frick Art Museum, which has a new exhibit since the time we visit in the spring.

Thursday, August 24, 2017

What Residency Looks Like II: Better Train Your Dragon!

This is my dragon, a special (=expensive) dictation mic that helps me prepare notes more quickly than typing. Except when it's misbehaving, which can be frequently, and then notes take longer because you have to laboriously fix the typos (speakos?) instead of just fluently typing a note (with abbreviations and half sentences). No joke, they have you sign up for a class to train your dragon by reading pre-set texts so that it understands your inflection and pronunciation.


Thursday, August 10, 2017

That's So Pittsburgh: Labor History

On Thursday night this week, after I got off of work and we had dinner at home, Dear Husband and I drove to the historic Pump House on the Waterfront in the south of Pittsburgh, where we joined the Battle of Homestead Foundation to watch an old black-and-white movie and talk about the class and steel industry in Pittsburgh. The Battle of Homestead was an actual shootout between members of a labor union and some Pinkerton's men on the Monongahela River on July 6, 1892. It was one of many violent clashes during the period before labor unions were legalized and recognized as a legitimate form of organization. Three unionists and seven anti unionists were dead at the end of the day. That strike at Henry Clay Frick's factory was unfortunately eventually broken. The BHF was founded to foster the history of Pittsburgh's working classes and industrial mills. The movie we watched was The Valley of Decision, which was originally the number two best-selling fiction book in the United States in the year 1942. It stars a very young and handsome Gregory Peck and a darling Greer Garson. Unfortunately the Irish accents were thick and neither the movie sound nor the speakers were very good, so it was a little bit like watching a silent film, as neither of us understood more than 50% of what was said. But we generally got the gist of what was going on: the spunky daughter of a mill worker crippled by an accident goes to work as a maid in the home of the mill owner. Of course she falls in love with the dashing oldest son, but can their relationship survive the class war of late-19th century Pittsburgh? Before the movie, a couple of labor history and movie aficionados spoke briefly about the organization, the book by Marcia Davenport, and the movie, which was once described in a newspaper review as "the Gone With the Wind of Pittsburgh." There was supposed to be a discussion afterwards too, and we were easily the two youngest people in the room of 30-40, but it was 9:30 at that point, and I needed to get home to go to bed for a day of work in the morning. Nevertheless, the movie was well acted, and free, so it was a nice date night.

You might like other That's So Pittsburgh moments, like eating in the Strip District.

Sunday, August 6, 2017

Happy 12th Anniversary: It's not all roses

I took Dear Husband to Altius for our 12th wedding anniversary. The evening did not start out well. I had just gotten up from a nap after my first 24-hour shift and hastily gotten dressed in the new frock DH had bought me for my birthday, but once in the car and running 10 minutes late, I discovered I had neglected to put on a slip and decided I didn't like the jewelry ​I had picked out (remembered the silk, forgot my pearls [traditional 12th anniversary gifts]). We pulled up for valet parking, and as I stepped into the restaurant, I broke a heel in front of everyone. After we ordered, DH decided to give me his anniversary card early, because of the message: it not all been roses, but we've walked the path together. We opened our other cards and decorated the windowsill with them, just like we did in his hospital rooms.

In our corner seat, we had an excellent view of the Three Rivers Regatta and the speed boat finals happening at the Point. That's what DH is paying attention to instead of his steak. (Isn't he handsome?) Behind him you can see the observation deck for the Duquesne Incline, from which the shorts-clad sightseers were watching us as well as the race.

The food was fancy: watermelon salad (above) and scallops for me, steak for the Mister. Our meal also came with two amuse bouches, unlimited bread with spreads, and two little dessert bites to take home with us. Like most fine restaurants, when we didn't have room to order a full dessert, they offered us a small complimentary​ one. The price is high enough that we will only eat dinner here for special occasions, but maybe we'll come back sooner to try their deconstructed desserts.

Over dinner, we tried to remember all the places we've gone to celebrate our anniversaries: Chicago, St. Louis/Kansas City, Indianapolis, Milwaukee, Cincinnati, Madison, San Francisco, Metropolis, and (over the coming Labor Day Weekend) Columbus. On occasion life has been too hectic for us to get out of town, but we do always try to dress up and eat good food in honor of another year as husband and wife. For instance, last year we celebrated our eleventh/steel anniversary at the Steel City restaurant named Eleven. Because, how could we not?

Wednesday, July 19, 2017

That's So Pittsburgh: The Pirates Parrot

That's so Pittsburgh: the Pirates Parrot sat at the end of our row, two rows from the visitors' dugout on the third-base side of PNC Park. Next he hopped up on the dugout, "danced" for us by wiggling his ample bum, refused to let a fan take a picture with his head in the parrot's mouth, and promptly melted into a puddle in the 90+-degree heat. At his feet you can see the two boogie boards covered in black tape that he uses like a flip cell phone.

Other TSPGH moments you might enjoy: Mrs. T's pierogies racing on the Jumbotron and Steelers swag spotted in our neighborhood.

Sunday, July 16, 2017

That's So Pittsburgh: Pittsburgh Botanic Garden

After church on Sunday, My Awesome Parents (MAP), Dear Husband (DH), and I (FrDrDr) drove a little ways southwest of the city to the Pittsburgh Botanic Garden. I had chanced upon a Groupon for reduced entry and happily snatched it up. On the way, we were treated to a hawk standing at the side of the road, just hanging out in the sun.

The decent-sized parking lot was relatively full, which suggests that the PBG is more popular than I had thought, not having heard of it the first year we lived in the city. There are many picnic tables set up under a big white awning next to a few kiddy games and a port-a-pot, but no trash cans: PBG asks that visitors haul out their garbage with them.

We enjoyed a delectable picnic at a table under an awning and then crossed the road to the gardens. Opened in 2011, the PBG is a work in progress on reclaimed land from a coal mine in Settler's Cabin Park. They have a formal garden for weddings and parties; a dogwood meadow with gazebo and birdhouses; a lotus and lily pond; and a couple of wooded trails. A "senses" garden is under construction. The trees provided welcome relief from the hot afternoon sun, and we were tickled to find the activity spaces set up for the young and young at heart: a hermit hut, a bookworm glen, and an enormous bird nest. There are also newspaper mailboxes in front of certain trees that let you guess the year the tree was planted and then tell you what was happening in the world that year.

I don't imagine that we will visit as often at the Phipps Conservatory, but we will definitely be back to discover what else they have done, built, and planted.

That's So Pittsburgh (TSPGH) has also visited Kennywood Amusement Park and The Strip District. 

Friday, July 7, 2017

That's So Pittsburgh: Eating in the Strip District

For Christmas, My Awesome Parents (MAP) gave me a gift certificate to 'Burgh Bits & Bites, a local tourism outfit that specializes in tasting tours in some of Pittsburgh's various neighborhoods. We finally found a chance to use it when the weather wasn't rainy, and I wasn't working. Destination: the Strip District, the 3/4-mile strip of land four-blocks wide between the Allegheny River and The Hill. It has a history of immigrants, enterprise (including the original Carnegie iron, later steel works), shipping, and wholesaling. In fact, 80% of the business conducted in the strip is wholesale (baked goods, cured meats, cheese, tortillas, etc.). Interestingly, of the 200+ businesses there, only two are not locally/family owned (McDonald's and Penzey's Spices). And they draw from a variety of ethnic and cultural backgrounds, including Italian, Syrian, African-American, Greek, Polish, and Mexican.

Our food and architecture tour started in the walled courtyard of Old St. Patrick's Church. The courtyard is a lush oasis in the middle of an urban, industrial landscape. The church was the first founded by Pittsburgh Irish Catholics and has the distinction of being one of only three in the world with scala sancta ("holy stairs"), which should be ascended on one's knees while reciting a litany of prayers. Our entertaining guide, Richard, also told us about the time the church burned to the ground in 1935 while the volunteer firefighters brawled over who would have the honor of saving it. The round tower to the right of the current building is the only part that survived the conflagration. Richard gave us freshly baked cinnamon bread from Mancini's Bakery to keep our hunger at bay.

Then we visited Parma Sausage for tastes of salami; Labad's Grocery for fresh hummus and warm pita; Prestogeorge to ogle their enormous coffee roasters; and Mancini's to peer in the plate-glass front window.

Next we contemplated restoration strategies for various buildings, from a rowhouse whose arched windows had been bricked up instead of having custom-made windows installed; an old cork factory turned into loft apartments; and St. Stanislaus, whose twin towers were damaged by the methane-fueled explosion of bananas ripening in a warehouse across the street in 1936 (yes, really; truncated towers below).

By this point it was mid-afternoon with little in the way of actual food, and Dear Husband and I were starting to get ravenous. So we were relieved to sit in the air conditioning and be offered greasy slices of pepperoni roll at Sunseri's. Alas, DH succumbed to the peer pressure to finish off the box, and I had eaten three slices with copious amounts of red sauce, so by the time we got up the street to S&D Polish Deli, we barely had room for our mashed potato and cheese pierogis (sharp cheddar cheese > sweet farmer's cheese).

Say "Cheese and Pepperoni!"
It turns out those were the main dishes of our tasting tour and that it was time for desserts. First was meles (fruit turnovers) from Colangelo's. Too bad they ran out of raspberry; DH had to settle for apple, while I chose apricot. We ate them for breakfast the next morning. Then came biscotti from Enrico: cherry for him, Black Forest for me. Of all the establishments we visited, this was the only one I had heard of (except Parma Sausages)--in fact, we had even met Enrico our first summer in the 'Burgh, at the little farmers market south of us. We haven't seen him this summer, as the market is even smaller than it was last summer, and we may have to find another one to patronize, as I prefer to buy organic produce from local farmers, not from people who are reselling others' products at marked up prices.

But I digress, much as we did on the tour, venturing down a covered alleyway into the former garage that is now Enrico's cafe, which offers brick-oven pizza at lunchtime and bread-baking brunch on Sunday mornings.
Finally, we trundled into the Stamoolis Brothers Greek grocery store, which offers an enticing variety of local and imported foods. They offered us little tasting plates of real Greek yogurt with orange preserves, French crostini with honey, nougat, cheese, and non-alcoholic ouzo soda. All in all, a warm but not wet afternoon getting to know our new city better. For the cost of our tickets we got all that food, a bottle of water each, and a tote bag. We were so full that we completely skipped dinner, and now we just have to decide which neighborhood to eat our way through next!

If you enjoyed this blogpost, you might like these other food-themed TSPGH entries: one about how making pierogis at home is easier than you think, and one about the tradition of Friday fish fries during Lent.

Thursday, July 6, 2017

What Residency Looks Like: Bag that Baby

Sometimes residency looks like more training for dealing with emergencies. After I intubated the plastic baby's stomach twice a row, one of the instructors drew me a picture with the helpful admonition​: "Intubate here!!"

Friday, June 30, 2017

What Internship Looks Like XLII: I just finished intern year!!

And th-th-th-that's all, folks! This is the last of the What Internship Looks Like posts. From here on out, this occasional photo series will be called What Residency Looks Like (WRLL). If you're ever nostalgic, just search for the tag WILL or WMSLL (What Medical School Looks Like).


Tuesday, June 27, 2017

What Internship Looks Like XLI: Blooper Edition

The last two years I have opened myself up to public humiliation by publishing a top-ten list of medical training-related blunders. As a third-year medical student, I once tried to find peripheral pulses on a patient's prosthetic leg. While traveling on residency interviews as a fourth-year student, I cataloged my various breakfast-related mix-ups. In the past year, there was typical clueless ‘tern behavior, like going to the “AOB” building instead of the “CHOB” building, or taking my chief resident's advice to park on the street for a weekend shift and getting a $40 ticket. But that's small potatoes compared to...

Intern Bloopers

10. One time I finished a gynecological exam and told the patient "everything looked/felt good" down there--and she called me on it. [We're supposed to say it was "normal."]

9. The time I was the third person to call the “wife’s number” listed in a patient’s chart, but it was really somebody totally unrelated who was nevertheless nice about it, even though the first call had come at 1am. I never found out why the night team believed this patient knew his wife’s phone number, given the fact that he was being admitted with delirium and had been found out of bed--more than once--stark naked, trying to stick his finger in an electrical socket.

8. The morning I thought I was going to have to call "jeopardy" (i.e. call out sick) when I slipped and fell getting into the shower, landed on my tailbone, and nearly blacked out from the pain. I just sat in tub until I could see again and had a righteous bruise for about a week.

7. When I tried to check extra-ocular movements by having a patient follow my finger with their eyes, and I knew the patient was blind. I wish I could say I only did this with one patient, but I would be lying.

6. And then there’s The Saga of the Wrong Cheesecake.

5. My first night shift at the children's hospital, when a nurse told me over the phone the good news about a patient's laboratory value. I expressed my sincere enthusiasm and thanks, hung up, and deadpanned to my senior resident, "What does it mean when XXX happens?" The other residents managed to hold in their laughter for about 30 seconds until they finally busted up and told me I deserved a b---sh-- award.

4. When I ordered an ICU patient's Versed drip for a Riker score of 0 (the nursing equivalent of "dead").
<1 dead="" equivalent="" neurological="" of="" p="" the="">
3. The time I text-paged "Not urgent" to the hospital pharmacy's code (i.e. emergency) pager.

2. The day in newborn follow-up clinic when I was jiggling a baby on my shoulder, and her belly button stump came off, on my white sweater. Of course it was bloody and stinking. I put the baby down, wiped off my sweater, moved my name tag to cover up the spot, and had to reassure the parents—twice, via interpreter—that really it was fine and normal. (Which was true but didn’t sound like it given the chain of events.)

1. The time my attending was interviewing an elderly patient in the hospital to try to determine whether she had dementia. He was asking her leading questions about her neighborhood, like what kind of dinosaur statue stands on the corner outside of Shady Lane School, “It’s a brontosaurus, isn’t it?” he asked. Suddenly I snapped out of my daydream and responded, “That’s right near my house—it’s a triceratops.” If looks could maim...


You may also enjoy Medical School Bloopers Part 1 and Part 2

Monday, June 26, 2017

Story + Recipe = Storecipe

Over at H-Net, on the H-Nutrition online community where I am an Editor, we are observing something called "What is a Recipe?" It's an unconventional kind of conference happening partly in person, partly on the interwebs, during the months of June and July. The folks over at The Recipes Project put out a call for proposals to address the question in whatever creative way we wanted. Some people are making YouTube videos, there's a gal growing potatoes and blogging about it, and lots of people are tweeting. We asked our list-serv members to write a short piece about their favorite recipe and what it has to do with the history of nutrition. I wrote about satiety and the stereotypically heavy Central European dinner; others tackled oatmeal (food for animals or children?), dehydrated rations for Indian soldiers during World War II, and even individualized recipes for Soylent.

One of the groups participating in What is a Recipe? invited us to their "Cooking with Anger" netprov (internet + improvisation) as a way to think about the influence of emotions on cooking and eating. I decided to give it a try. Here's my storecipe (story + recipe) with the automatically generated list of ingredients and "spices." Click the link in the story to find the recipe.

Level: Chef

Your basket
Main Ingredients:

Spice Pack:
1/3 cup of love
1 teaspoon of nervousness 

I heard the door of my apartment slam and the squeak of worn springs as my step-sister threw herself onto the futon in the living room. “I can’t believe that fink got away with it!” she said.

“Who’s a fink?” I asked, drying my hair with a towel as I came out of the bathroom. It was 7AM on a Saturday morning, and Janice had been gone all night clubbing.

“A pickpocket on the subway,” she answered juicily, around a mouthful of mango. She must have spied the fruit bowl on the kitchen counter as she entered. “This one’s really good!” she said, and cut another piece.

“I should hope so,” I countered. “They’ve been ripening for the last week.” I took the slice she proffered me on the flat of the knife blade. “What did he or she take?”

“My cellphone with IDs—right out of my back pocket!” said Janice. “Do you think I’ll ever see them again?” she asked nervously. “I’ve got to catch the train back to Philly this afternoon.”

“Maybe, maybe not, sis,” I replied. “It’s unfortunate but not all that uncommon here in New York. I’m sorry that happened to you. Let’s make some phone calls to your bank and the DMV, and then I’ll fry your some kohlrabi fritters before we head down to the train station.”

Janice sighed a combination of frustration and satisfaction, ran her hands through her hair, and then laughed when her sticky fingers caught in her curls. “Sure, let me shower and look up the numbers on my laptop. Thanks!”

She gave me a wet kiss on the cheek on her way to the guest room, while I headed for the kitchen.

Thursday, June 22, 2017

That's So Pittsburgh: Kennywood Amusement Park

Finally with some vacation at the end of the academic year, about 1/3 of the Pediatric residents decided to have a day at Pittsburgh's famous Kennywood amusement park (est. 1898). We rode a variety of roller coasters (sometimes more than once), spinning rides, and water rides; cheered each other in the carnival games; and ate fair food (funnel cake, ice cream, chicken fingers/fries, lemonade, burgers). While standing in line, we watched the daredevils who had paid extra money for the Skycoaster "free fall" ride, chatted about past and future rotations, and compared childhood experiences of visiting amusement parks. Yes, the pediatricians even rode the carousel. My favorite ride was either the Sky Rocket, a modern looping roller coaster, or the Racer, a wooden coaster with side-by-side tracks. "My" car won the race, and I may have yelled "See ya later!" to the losing car as we passed them in the home stretch. My least favorite was the Thunderbolt, another old coaster that jostled too much. The funny story about the ride pictured to the left is that when we rounded the corner and saw that there was no line for it, we all agreed to give it a try, without much of an idea of what it actually did, which was to swing so far and so high that--at the apex--you were above horizontal, staring down at the ground very far below you. Needless to say, some of us expressed pure terror at that part! All in all, an excellent day of camaraderie marred by neither rain nor sunburn. Even the humidity was bad but not unbearable; and the rainy forecast likely kept away some of the crowds.

Wednesday, June 21, 2017

What Internship Looks Like XL: Historical Dietetics Noon Conference

Me at the podium; photo credit M.V.
Sometimes internship looks like giving the very first noon conference to the new Pediatric interns. In the first part I made an argument for the usefulness of medical humanities to clinical medicine (aka "why I did not waste 8 years of my life earning a PhD"); in the second part I presented a case study of two little boys who took sick in Dresden during World War I; and in the last part I explained the current clinical guidelines for the treatment of acute gastroenteritis (the BRAT diet is no longer "state of the art" when treating vomiting and diarrhea).

At Housestaff Lunch later in the week, a very kind senior resident submitted a kudos that was shared with the whole program:

Kudos to Kristen Ehrenberger for her awesome noon conference this week - your fun and enthusiastic ability to blend historical context with practical recommendations made for an awesome hour. What a great way to kick off the year for the new ‘terns!  P.S. I would fund a kickstarter for a weekly “Medical Story Time with Dr. E”


Friday, June 16, 2017

What Internship Looks Like XXXIX: Reading in the Atrium

Sometimes internship looks like reading a book about food and hunger in 20th-century Germany while sitting in the warm sunshine of a hospital walkway atrium. Later on the agenda: lunch with the Narrative Medicine group and then primary care clinic in the afternoon.

P.s.--Go Penguins, Stanley Cup champions for the second year in a row!


Tuesday, June 13, 2017

Book Review: Feeding the Nation Left a Sour Taste

In my last blog post, I described an academic study of hunger, food, and cultural racism in twentieth-century South Africa that is so prize-winningly good that it intimidated me as a writer. Let's just say that the next book I picked up engendered just the opposite feelings. For a book with a title like Feeding the Nation: Nutrition and Health in Britain before World War One (2010), I can't believe it wasn't on my radar before this spring. But Yuriko Akiyama's dissertation/first book seemed to promising that I went ahead and purchased it. Her argument is simple: cookery teachers, nurses, and other "educationists" (a British word I had to look up that means "educators") taught nineteenth- and early-twentieth-century Britons both nutrition and hygiene through lessons about food preparation and consumption. 

However, Akiyama conflates teaching with learning. This is pitched as a study of reception, but she offers precious little data about what the trainees thought of their lessons. I don't really fault her for that, because designing a reception study is hard (I know, I've tried); the answer is to frame your work as a discussion of other people's discussions, of what they wanted to convey. Unfortunately, she seems to take many of her primary sources at face value, blithely recounting their letters, speeches, and booklets. This may be one reason why the timeline of events in each chapter is so confusing: because each author rediscovered the importance of food for health in order to justify the importance of their particular program, it seems like the thread of the argument that cookery was recognized as important for the health of individuals and the nation is constantly being dropped and picked up again. She sometimes explains a particular idea as "now/suddenly/finally" being perceived as important once some reform has happened, which neglects the interest that had to exist beforehand to generate the political and social will for that reform. It also doesn't help that she argues for the importance of Florence Nightingale in the development of cookery and hygiene and then mentions at one point that real change required 30 years. In the long duree that's nothing, but in real time three decades an entire generation.

The other difficulty that arises from Akiyama taking her sources at face value is that she adopts their disapproving, reformist tone, especially toward the lower classes. Although she includes such important details as the fact that many poor Britons lived in hovels or tenements without private cooking facilities, she nevertheless makes comments about how uninformed and unhygienic they were. She confuses lack of knowledge with lack of will or ability, when there were manifest structural and institutional hindrances. This is important, because on the one hand she argues that the army taught every man to cook his own rations to ensure that nutrients would not be wasted by an inexperienced (non-British/foreign) cook, and then later she notes that the navy trained professional cooks so that all sailors could benefit from good, hygienic food. Somehow both are supposed to convey the same message about the importance of diet on health, when I suspect the army was mostly concerned about cost cutting. I will concede her one point though, which is that just because hygienic structures and routines have been created doesn't mean that individuals will absorb the lesson (I think of soldiers defecating outside of their tents because it's more convenient than going to the communal latrine).

The best part of the book is that she tried to cover a variety of sites: schools for cookery teachers, elementary schools, hospitals and nursing schools, training for soldiers and sailors. In this way she covers girls and boys, women and men. I wish she had spent more time on the recipes that were taught, rather than talking about the educational institutions, but then I would have written a different book. And maybe I will.

Monday, June 12, 2017

Starving on a Full Stomach: An Intellectual Feast for the Mind

Image result for starving on a full stomach wylieDo you remember that time in medical school when I pledged to read one book a month? Predictably, the streak didn't last very long, although in my defense, I had joined a year-long Bible study, in addition to reading many other, shorter things. Since then I have published the occasional book review, more out of a need to make me sit down and grapple with than because I think most of you want to know about any one of these books. Residency has kept me too busy to do much blogging, but I looked up the other day and realized I had read five books in the last three months, with 2-3 books scheduled for the rest of my current block of time off from clinic for research. I want to share two books with you that had opposite reactions on me.

The first book is Starving on a Full Stomach: Hunger and the Triumph of Cultural Racism in Modern South Africa (2001). It had been on my to-read list since before I presented a paper at a medical humanities conference in Johannesburg, South Africa, in 2013. Starving on a Full Stomach was Wylie's second book, and it has all the markings of the product of a mature scholar--namely, that it is so well written that it makes me doubt I will ever be able to publish anything half as good. Other scholars agree: it won the Melville J. Herskovits Prize from the African Studies Association in 2002.

Wylie uses arguments about food, hunger, and nutrition in the eastern part of South Africa to track the development of the cultural racism that buttressed the apartheid state for more than 40 years. (It was not biological racism, because scientists had shown that all human bodies were comparable; if Blacks and Whites had different life experiences, then this must be explainable by habits and beliefs = culture.) At first Europeans treated the mostly rural African population with paternalism, using the language of the patriarchal family to justify White rule over Black "children," just as native Chiefs had power over their tribes. However, colonial policies that enriched White miners and farmers at the expense of Black workers--such as artificially low wages, artificially high food prices, and crowded native "reserves"--put more and more impoverished Africans in the position of needing help that the government was unwilling to supply after World War II ended.

She argues that the apartheid state was "modern" in so far as it had scientific backing, such as the nutritionists and social scientists who claimed that Africans could not feed themselves and therefore--implicitly or explicitly--did not deserve political rights. As paternalism gave way to scientism (over-regard for scientific-sounding explanations), the apartheid government formed in 1948 no longer accepted any responsibility for Black health, envisioning separate "homelands," foodways, and "self-sufficient" socio-cultural spheres. One of their favorite hobby horses was that Africans were mismanaging their land and cattle, such they no longer produced enough food to nourish their families. This assertion conveniently ignored the fact that Blacks had been ejected from cities and crowded onto too little land for too many people (and cows). Even most of the politically moderate physicians and researchers examining the question of the nutritional health of native Africans described the problem as one of knowledge instead of one of structures of oppression. Finally, at the bitter end, when these scientistic explanations for Black poverty had lost their luster, the apartheid government justified its continued existence with naked power and brute force.

Things I learned:
  • Thomas Malthus predicted that a growing population would outstrip its food supply, leading to famine and a necessary reduction in the population. What he did not account for was the agricultural revolution that increased food production exponentially. While modern societies no longer suffer widespread famine, some of their members do experience hunger. Hunger in industrial capitalism is a problem of food maldistribution rather than one of insufficient food production.*

  • Europeans typically held a static view of African culture as "a food-sharing entity" and assumed that Africans preferred private gifts of food among each other to higher wages from their White employers. How conveeeeenient, as The Church Lady might say.

  • The word "famine" was thrown about a lot. Africans often thought of "starvation" as a synonym for "poverty," while Whites saw it as a description of Blacks' eternally helpless state. How mind-blowingly aggravating that the government never adopted any of the suggestions Blacks offered for their own betterment.

  • It was possible to be "starving on a full stomach" if the person had moved to town and replaced their milk, grain, and vegetable-heavy rural diet with processed foods and sugar. To want meat but not be able to afford it was another kind of hunger.

Look out for Part II of this series, a review of Feeding the Nation: Nutrition and Health in Britain before World War One (2010) by Yuriko Akiyama.

*I am now in the middle of Modern Hungers: Food and Power in Twentieth-Century Germany by Alice Weinreb; when I get to the last chapter, on obesity, I hope she talks about how an abundance of food encourages over-consumption, which in our health-conscious western culture typically leads to dieting = voluntary hunger.

Editor's Note: If you liked this post, Frau Doktor Doctor has previously reviewed a book about German measles and birth defects; a book of essays by historians of medicine who are also practicing physicians; and a number of audiobooks she listened to while driving around the Eastern United States for residency interviews.

Sunday, June 11, 2017

TSPGH: St. Paul's summer organ series

That's So Pittsburgh: an organ concert on a Sunday afternoon at St. Paul's Cathedral. What's unusual: getting to sit up in the organ loft to watch from 10 feet away. I've seen Dear Husband play the organ from closer, of course, but this was special as the drifting clouds outside changed the brightness of the sunlight streaming in trough the beautiful stained glass windows. Up here, not only do pipes jut overhead, but you can hear the sounds of the mechanical stops, and occasionally a large, deep pipe vibrates under foot.

Wednesday, June 7, 2017

That's So Pittsburgh: Churches Doing Good

Dear Husband and I have visited many, many churches in Pittsburgh and finally landed at Third Presbyterian Church (Fifth & Negley). One ministry with which Third Pres is very active is the international charity Days for Girls, which produces reusable cloth sanitary kits for disadvantaged schoolgirls. (I admit I have some reservations about the whole idea: why not provide them with more durable menstrual cups, without all the expenditure of money, labor, and time that goes into making the kits?)  As it is, Days for Girls has two arms: volunteers in wealthy communities and micro enterprises in a handful of developing areas.

What happens here is that people donate cloth scraps and hotel soaps, time to cut/sew/assemble the kits, and money for postage. The free kits (and some basic hygiene education) are intended to help their recipients continue to attend school, avoid pregnancy, and eventually learn/work their way out of poverty. With a light clinical schedule for the last month, I have been stopping by for a couple hours to cut and sew. The Viking sewing machines are *a little* less cantankerous than my mother's old Singer, and if the noise is not too great and my neighbor hasn't got headphones in, we chat about the Pride parade, or superhero movies, or the difference between Presbyterians and Methodists (besides "debts" versus "trespasses," not much, in practice). It has been a relaxing and rewarding break in the middle of my week, and I'm sorry that it will soon be sacrificed to the grind of rotations.

Saturday, June 3, 2017

Copenhagen: Thorvaldsen Museum

In 1796, Danish artist Bertel Thorvaldsen (1770-1844) left Copenhagen for Rome, where he spent most of his artistic life. When he returned for good in 1838, he was such a successful sculptor that he decided to donate his works to his natal city. So they built a big, colorful museum to house his marble sculptures, plaster casts, paintings, and collections of ancient jewelry and coins. Below is one panel from the enormous frieze that envelops three sides of the three-story building, depicting Thorvaldsen's arrival in Copenhagen with all his art. To the left is the impressive main facade; actually, you enter through a door on the side of the building to the right. We were pleasantly surprised to discover that the museum is free on Wednesdays, the day we were there. Initially I had planned to stay for only an hour to look at a special exhibit on Eden, before walking a few blocks to the Tivoli Garden. However, the weather was too cool and gray for us to want to spend money at an amusement park; and while the Eden exhibit was a bust, we found the rest of the museum sufficiently interesting to keep us busy for three hours!

The main floor is composed of long corridors with statues around the courtyard where the master is buried. These are surrounded by a series of small rooms--each painted in one bold color, with a patterned, tiled floor, and a brilliant, painted ceiling--containing one sculpture and a few bas reliefs.

It looks like a fun house, doesn't it? The lady on the right is Maria Fjodorovna Barjatinskaja (1793-1858). Apparently the sculpture was finished in 1825 but never delivered, so it came back to Denmark with Thorvaldsen. He died first, and then her. Her family demanded the sculpture but ended up accepting a copy by an apprentice.

I particularly liked this relief because of the nonchalant posture of the man on the far right. You can see how talented Thorvaldsen was in his figurative representations. One half of the second floor consisted of painting galleries grouped by themes. I think the representative one below was "Italian." The half contained Thorvaldsen's original glass cabinets with his curiosities; depicted is part of his Egyptian collection.

This was a neat find that I only chose because it was one of the earliest things to open (10AM). While we were there, Danish school children were completing geometry worksheets in some of the rooms, which echoed with their chatter. So I guess it's familiar to the locals. Dear Husband and I happened to luck upon a short video in the basement the outlined his life and career; but otherwise the museum could do a better job of educating visitors about the artist. Nevertheless, I would recommend the Thorvaldsen Museum to any art-minded foreign travelers.