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).

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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").

3. The time I text-page "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...

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

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:
step-sister
pickpocket
mango
kohlrabi
futon

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 you 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.

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.

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”


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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!

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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. 

Image from "Books for Cooks" by the British Library.

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.

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

Do 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.

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.

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.

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.

Scotland: Highland Folk Museum

Our next AirBnB was down in Newtonmore, so after spending the middle of the day on Cairn Gorm Mountain, we stopped at the open-air museum on the edge of town. Entrance is free, but since it costs them 11 pounds per visitor to pay their actor-interpreters and keep up the grounds, we went ahead and donated 10 pounds each, plus 5 pounds for the guide book. The weather mostly held out for us as cool and gray, with only a smattering of light rain toward the end of our three-hour visit.

(A week's rations in Britain during WWII.)



The Highland Folk Museum is a mile-long stretch of land to which a number of old buildings have been brought. On one end is an animal farm, complete with nicer and shabbier farm houses. (See Dear Husband milking Bessie, above.) There's also a vehicle garage from the interwar period and a house that trebles as middle-class parlor, sweet shoppe, and post office. In the middle is a town c. 1930, with a school, a church, a tailor, a clockmaker, etc. The school was the very last place we stopped, shortly before closing time, and when the schoolmaster reprimanded us for being late, at first we thought he was playing his part, but really he wanted us to know that the place was closing! Our AirBnB hostess sometimes plays a schoolmarm there.

Above is the table in the little shepherd's hut; below is the stone paddock for sorting sheep brought in from the pasture for shearing, dipping, or other procedures.

Here's the counter of the little post office.

A short walk through the woods gets you to an eighteenth-century village of wattled dwellings with thatched roofs. The houses, barns, and drying kiln were sturdy structures, but the insides were dark and smokey. I readily understood what a dirty existence it must have been. There were two actors present while we were there, but the man didn't seem interested in conversation, and the woman ran off to intercept a couple who were trying to trespass onto neighboring land.

It was a neat experience. The 20th-century presentations looked pretty familiar to our American eyes, but the 1700s settlement was new and different. I'm glad we went, even though I hadn't been expecting to pay money for it.

Scotland: Loch Ness & Urquhart Castle

On our last day in Scotland, I had planned for us to take a boat tour of Loch Ness and Urquhart Castle. We woke up that morning in Newtonmore, a good hour south of the Jacobite dock, and thanks to road construction and "Sunday drivers" (there's the phrase again!), we quite nearly missed the boat. Skidding into the gravel parking lot with mere minutes to spare, Dear Husband ran to the booth to pick up our tickets, while I grabbed a few things from the car. Between us we had two jackets, one hat, and one scarf, and it was half as much as we needed out on the blustery lake. Scottish weather had finally caught up with us, and we were not ready.

Nevertheless, we braved the wind and cold for the hour-long journey out to Urquhart Castle, a tourist trap if ever there was one.

First things first: no, we did not see the Loch Ness monster. Mostly we watched the water and steep hillsides, with gorse bushes, trees, a golf course, and sheep, while a very entertaining young Scotsman rolled his "r"s and chattered on the PA system about the loch (it's not a lake, it's a loch). Loch Ness is the UK's second largest lake by surface area and second deepest (to 754'), but it contains the largest volume of fresh water--more than the rest of the lakes in England and Wales combined. Below 100 feet, the water is a constant 44 degrees F; above that the temperature fluctuates but never gets cold enough to freeze over.

The tour company is named for the Jacobite Rebellion in the late 1600s, the failed attempt to put a Catholic monarch back on the English throne, after King James II was driven into exile in 1688. Clans living in the Scottish Highlands were some of his and his son "Bonny Prince Charlie"'s most ardent supporters.

Urquhart Castle is a ruin of Scottish wars for independence from England. Picts may have occupied the area in the late 500s. St. Columba, who converted the Scots to Christianity, is said to have talked down a loch monster who was trying to eat a servant about that time. The first medieval stone castle was built in the 1200s. Strategically situated on a promontory, it changed hands many times and was finally dynamited in 1692 by retreating Crown forces. We joined the throngs (3/4 German tourists?!?) in visiting the various "rooms" and waited our turn to climb the narrow winding staircase up Grant Tower (it wasn't all that great). A chapel existed for a few decades before the space was converted to weapons storage (go figure). Having seen everything, we bought sandwiches from the visitor center and spent a little bit of time looking at the exhibits before catching the last possible showing of the short documentary that ended with the screen being raised and the curtains opened to reveal the castle down the hill. They also have a working trebuchet on the grounds; no word on when they hold demonstrations.

On the way back it had begun to sprinkle. The boat was less crowded, so we sensibly decided to ride in the enclosed cabin. I wanted to try a spiked hot chocolate from the snack bar, but the cost was too dear, so I settled on a pair of Nessie stuffed animals as Christmas presents. Alas, neither of us remember to pee before we disembarked, so we spent ten minutes looking for a restroom before heading 3 hours to the airport and consequently didn't think to snap a photo of our vessel, so here's one from their website of the "Warrior" in all her glory, with Castle Urquhart in the foreground.

If you want to read more about our trip to Scotland, check out this post about hiking Cairn Gorm Mountain, this one about death and dying in Victorian times, or the one about going to church with Queen E.