Wednesday, January 31, 2018

What Residency Looks Like XV: Wellness Week


Sometimes residency looks like DJing a YouTube Disney sing-along with your Pediatric colleagues over lunch.

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Sunday, January 21, 2018

What Residency Looks Like XIV: Truth-Telling

Not too long ago, I woke up in the middle of the night, and my anxious brain decided to enumerate all the ways in which I am a bad resident and will do a poor job leading my first team in a few months. It went on like that for an hour or two before I finally fell asleep again. In between negative thoughts, I flipped through my mental Rolodex of friends in whom I could confide. Then I resolved to seek formal counseling to explore what my rational brain deemed were understandable but unfounded fears. A couple of days later, I finally sat down with a pen and a piece of paper to write a pro/con chart, to see if I could untangle my strengths and weaknesses. It struck me immediately that there are more items in the positive column than in the negative one. This is what I came up with:


Evidence I am a good resident

My colleagues think so.
In the last two weeks, two more-senior residents, one Chief Resident, one program director, and one fellow have praised me for my hard work, skill, demeanor, or willingness to set a good example by sitting in the front of the room when everyone else tries to look inconspicuous in the back.

Voted into Ravenclaw without hesitation.
While inner-tubing with fellow second-year Pediatrics residents last August, the conversation came around to which Hogwarts House each of us belonged. My colleagues all agreed I was a Ravenclaw. I confess I hadn't thought much about this, perhaps assuming I was a Griffyndor. However, I just took the Pottermore Sorting Hat quiz, and sure enough, it lumped me in with the house of "intelligent, wise, sharp, witty, individual [read: weird]" witches and wizards.

"[I] have good clinical judgment."
This is one of my favorite compliments from an attending physician who has literally written the book on diagnosis, given toward the end of a week of nights at the children's hospital, after he had read my notes on new patients.

"[I] can talk to a variety of patients."
Another attending compliment, this one from watching me interact with patients on rounds one or two mornings a week, and one I take to heart, because I was not always so conversational. It also suggests that while I prefer interacting with over-educated people like me, I can modify how I approach someone with different knowledge and life experiences. Current learning goal: how to put reticent adolescents at ease and yet extract useful clinical information from them.


"Or yet in wise old Ravenclaw, if you've a ready mind,
where those of wit & learning will always find their kind."
By Niongi, DeviantArt

Attendings and nurses like to work with me.
As a second-year resident, it has been encouraging to work with attendings and nurses a second time around who know me and what I am capable of.

I write good notes.
Probably my notes are sometimes "too good"--I know I can be a perfectionist, but as a historian and therefore a writer, I judge myself by how well I communicate through text. I often take the time to synthesize and carefully phrase my clinical reasoning in my notes. By contrast, I am not as gifted with on-the-fly oral presentations, and I worry that others judge me for this.

Patients want me to be their doctor because I am honest, thorough, explain things well, and have a good bedside manner.
Getting compliments from patients is the highest praise. They buoy my morale amidst lectures from consultants about what the night team did (or didn't do), the frustrations of the hospital/healthcare system, and the devastation wrecked by pathogens, time, and trauma on human bodies.


Evidence I am not a good resident (I tried to frame the discussion already by avoiding the phrase "bad resident.")

Middling In-Training Exam Scores
The entire time I was in school, I was a/the top student. Now that I am in residency, I am surrounded by excellent students. I've taken three standardized exams so far, and on all of them I have been middle of the pack. My program director and I came up with a study plan to address my deficiencies with practice questions, but I still feel that by the time I have completed four years of residency, I will have learned what I need to know. Besides, while standardized exams are now a constant feature of medicine, they are not the most important part.

"You know you're a Ravenclaw when...
you do not like a person based on their looks
but by how much smarter they are than you."

Pretty much how I fell in love with DH.
Don't feel I know as much as my peers.
This is probably true in some areas and not in others. But I have rarely felt judged for it.

I sometimes take 1/2 histories or give 1/2 plans.
This is an area of growth for me: remembering all the right questions to ask and knowing (or looking up) what to do next. The most important thing I need to do is to ask my preceptors to let me come up with a plan for them to critique, rather than bring them information from the patient and then just trail off, letting them fill in the blanks...

Got little out of M4.
What I did or didn't learn in my last year of medical school while traveling for residency interviews, trying to get an article published, packing up/selling our house, and taking care of Dear Husband is in the past, and I can't let it dictate how I approach present or future challenges. I will be trusted to do the job of leading a team because I can.

Finally, something I realized while mulling these things over is that I have developed an unhealthy relationship to praise. By nature I have high standards for myself and others. By high school, however, I had learned that always being right was off-putting to my peers, and so I started to deflect praise. There's a fine line between gracefully accepted positive feedback and downplaying success to make other people feel better. In the process, I made myself feel worse. I have resolved therefore to change my attitude from embarrassment to humility and to start believing people are telling the truth about me when they say I am a good resident and a good doctor.

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Friday, January 12, 2018

What Residency Looks Like XIII: Taco Friday


Sometimes residency looks like Taco Friday + a "crack brownie" before Neuro conference.

Editor's Note: An explanation for people who don't understand Taco Friday: it's so you can go out for Taco Tuesday AND have tacos at work on Friday. If you can't have a taco truck on every corner, tacos for two meals a week is the next best thing.

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Sunday, January 7, 2018

FrDrDr's Book Pile from 2017

I have made a variety of resolutions regarding reading and kept few of them. However, when I gathered together the books that I did read over the last calendar year (or so), even I was impressed by what I had accomplished, helped greatly by having an entire 6-week rotation devoted to research. Here is an annotated bibliography with my recommendations.

Deborah Blum, The Poisoner’s Handbook:Murder and the Birth of Forensic Medicine in Jazz Age New York (2010)
Engagingly written and cleverly crafted, it weaves together histories of the new science of toxicology, the first forensics department, and Progressive and Prohibition Era New York City. I can recommend it to anyone with an interest in the history of science and medicine, in social reform, or in the sordid details of other people’s love lives and get-rich-quick schemes. Did you know that the United States government poisoned industrial alcohols during Prohibition to discourage their reformulation into potable alcohol? And that many Americans were blinded or killed because they didn’t know or didn’t care? I have recommended this book to an ICU fellow, my bookworm of an aunt, and my nerdy youngest brother. I bet you would like it too.

Rafael Campo, What the Body Told (1996) and Alternative Medicine (2014)
When Rafael Campo visited Pittsburgh for a reading, I knew he was a physician-poet at Harvard but was not familiar with his work. Afterwards I bought two of his books and fan-gushed all over him in the autograph line. This is what he wrote for me: “together in being ‘a little weird’” and “in the spirit of healing.” A fellow medical humanist, he lives the tension between medicine as an art and as a science. Medicine is better for it. He has a talent for capturing the pathos, contradictions, and moral failings encouraged by a medical system that frequently puts profits over people. Winner of a Lambda Literary Award for Gay Men’s Poetry, What the Body Told eloquently captures the helplessness of being both a gay man and a physician in the early HIV/AIDS epidemic. Alternative Medicine contains poems both about his family (father, partner, children) and his medical practice. Campo is particularly adept at structured verse, and I delighted at parsing the stanzas that adhered to some rule and yet yielded fluent lines. I want to re-read these so that when I lead a floor team I can have a related poem at hand when patient-care issues arise.


William Maxwell, They Came Like Swallows (1937)
I chose this little novel because it straddled the line between “work” and “pleasure,” being a fictionalized account of one Midwestern family’s encounter with the 1918 Influenza Pandemic. The title comes from a line of a William Butler Yeats poem: “They came like swallows and like swallows went,/ And yet a woman’s powerful character/ Could keep a swallow to its first intent.” Each of the three chapters is written from the perspective of one Morison boys/men: the younger son, the older son, and the husband/father. The woman of powerful character is Elizabeth Morison, whom the reader sees through the eyes of those who revere her. It bothered me that she did not get a chapter of her own, but maybe I shouldn’t have expected as much from 1937. Nevertheless, for what it is, it is an affecting account of boy- and manhood. I am trying to get the Pediatrics Book Club to read it in honor of the coming centenary.

T Cooper, Lipshitz (2006)
As I mentioned in a post when I started this book, I bought it to practice my German, only to discover it was a translation of something originally written in English. As a historian, I found the first 2/3 of the novel the most interesting, as we follow the Lipshitz family from rural Poland to New York City to small-town Texas. The key event is the disappearance of 5-year-old Ruben when they all land at Ellis Island. His mother, Esther, who was ambivalent about her maternal responsibilities, sublimates her grief and guilt into an obsession with Charles Lindbergh, whose birthday was one day off from Ruben’s and who grew up to recapitulate the loss of a son. The last 1/3 of the novel introduces the author as a character, great-grand-nephew of Ruben, who has assumed the identity of rapper Eminem. It turns out that T is transgender, which opens up all kinds of questions about assuming a new/true identity, as explored through realistic fiction.


Memoir 6 of 1: Childhood (2015)
This interesting book from Ponies+Horses Books is six short memoirs bound together with the common theme of “childhood.” They range from Andrew J. Fitt’s and Tracy Craig’s first-hand accounts of growing up with cerebral palsy and Tetralogy of Fallot congenital heart disease, respectively, to Hillary Savoie’s coming to grips with her medically fragile daughter having a very different childhood than the one of which she had dreamed while pregnant. The mixed quality of the writing reflects the authors’ variable backgrounds. I think I will recommend this book to the physicians who are putting together a curriculum for medical students and residents rotating through the new special-needs clinic.

Michael Sappol, Body Modern: Fritz Kahn, Scientific Illustration, and the Homuncular Subject (2017)
You know the famous picture of a human body designed to look like a factory? That was the brain child of Fritz Kahn, a German-Jewish ob-gyn who emigrated to the United States in the 1930s and popularized science and medicine. This book is all about the idea of the efficient modern body and helping people in the early 20th century understand themselves in an increasingly technologized world. Kahn was basically an enchanted mechanist who preserved the idea of an individual subject with agency despite a world (and a body) made up of machines. I waited for this book for many years and need to re-read it so I can better incorporate it into my own work on the history of bodies.

Alice Weinreb, Modern Hungers: Food and Power in Twentieth-Century Germany (2017)

This was another important book for my historical scholarship, on the place of hunger in modern Germany, whether that caused by the Allied blockade during WWI, the collapse of the Germany economy after WWII, or by dieting for fad or fitness later in the century. Weinreb does a good job teasing out some of the gendered implications, such as West German schools letting out at 1 o'clock so children could go home for lunch with their mothers. This schedule is still seen in German schools today and makes it difficult for some women to go back to work after having children. Meanwhile, East Germany tried to feed its schoolchildren cafeteria lunches, but its mothers--who by and large worked outside the home--rebelled, preferring to feed their children themselves on their lunch breaks.

Ian Miller, A Modern History of the Stomach: Gastric Illness, Medicine and British Society, 1800-1950 (2011)
Given its sweeping title, I expected more from what turned out to be a single-country case study of the evolution of the idea of "dyspepsia" and stomach ulcers. For all its narrow, internal focus, it's relatively well research and written, and Miller deserves some props for choosing examples that stretch out over a century and a half. I was surprised it wasn't (more) referenced at the conference I attended in Aberdeen on digestion in the long nineteenth century.

Manfred Berg & Geoffrey Cocks, editors, Medicine and Modernity: Public Health and Medical Care in Nineteenth- and Twentieth-Century Germany (1997)
This is a collection of essays, some of which I had read before, with which I wanted to refamiliarize myself. It covers everything from hospital food in the mid-1800s to psychiatry during/after WWI to the crisis of professionalization in the late-1900s, as (West) Germans came to grips with the fact that many former-Nazis had continued to enjoy successful careers with little in the way of consequences for their actions during the Third Reich.

I have already blogged about how much I liked Diana Wylie's Starving on a Full Stomach: Hunger and the Triumph of Cultural Racism in Modern South Africa (2001) and how much I disliked Yuriko Akiyama's Feeding the Nation: Nutrition and Health in Britain before World War One (2010). I just couldn't make myself finish Walter Gratzer's Terrors of the Table: A Curious History of Nutrition (2005), which reads like nothing so much as a diletantish retirement project, in which Gratzer researched a variety of anecdotes and then compiled them one after the other. If there's any argument to the book at all--I made it four chapters and 70 pages in--it is a Whiggish one of Progress.

For Pediatric Book Club I listened to Swing Time (2016) by Zadie Smith while commuting, and I read Exit West (2017) by Mohsin Hamid while exercising. I'm supposed to be picking up Autumn (2017), by Ali Smith next.

I can't remember if I finished these books in 2016 or 2017, but the pile also included

  • The Princess Bride: S. Morgenstern's Classic Tale of True Love & High Adventure (1973), by William Goldman. I can't believe I have been a TPB fan as long as I have been and didn't realize that the movie was based on a book. As soon as I did realize it, I purchased the book and Cary Elwes' memoir for Dear Husband for Christmas 2016, and we read them together. The exercise reminded me how different the genres of print and film are, and at first I balked that the characters on the pages were not the beloved ones I knew from the silver screen. But by the end I appreciated the character development captured in the book that had to be cut in the movie.
  • Cary Elwes, As You Wish: Inconceivable Tales from the Making of The Princess Bride (2014). High-brow literature this is not, but I did appreciate the behind-the-scenes view. Favorite part: dissolving into laughter with DH about the time the film crew bust a gut with Andre the Giant over his noxious farts.
  • One Shot at Forever: A Small Town, An Unlikely Coach, and A Magical Baseball Season (2012), Chris Ballard's engagingly written recreation of the Macon High School baseball team's made-for-tv-movie run at the state championship in 1971 that was a farewell gift from AS.
  • Charles Dickens, A Christmas Carol (1843). Does it count if Dear Husband did most of the reading, and I fell asleep listening? He also tried some Nathaniel Hawthorne, which I found more interesting than I thought I would, and some Edgar Allan Poe, which I found less interesting.
  • Eric Topol, The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care (2012), which Dear Husband bought for me and I appreciated more after it was mentioned at a Grand Rounds talk.

Next on the docket:
  • Cristin O’Keefe Aptowicz, Dr. Mütter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine (2014), a Christmas present from the nerdy youngest brother about the founder of the (in)famous museum in Philadelphia.
  • Henny Beaumont, Hole in the Heart: Bringing up Beth (2016), a graphic novel about the author's daughter, who has Down Syndrome.
  • Caleb Carr, The Alienist (1994), which failed to make it to the big screen has now been made into a television series.
What was your favorite book from 2017? What are you reading in 2018?

Thursday, January 4, 2018

What Residency Looks Like XII: A Little Light Reading

Sometimes residency looks like falling down a rabbit hole researching an interesting disease after you, a fellow, a visiting resident, and a medical student show up to see clinic patients with the attending, but all of the morning patients no-show.


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Tuesday, January 2, 2018

Rememberlutions 2017

Since January 2015, I have kept a decorated glass jar on a shelf as a place to store reminders of things I want to remember about the previous year. You can find my posts about 2015 and 2016 by clicking. Because these early years of medical training tend to involve a lot of doubt and self-recrimination--as well as long working that seem to preclude having time for fun and relationships--I like the idea of pausing to look back at my accomplishments and positive experiences. This blog post is mostly a personal exercise in gratitude, but I share it with you in case you are curious about what went on with me over the last year. I don't expect you to read all of it, but maybe leave a comment at the end with one of your favorite memories of 2017.

To be honest, my favorite memories from 2017 are every time I hugged a crying mother, or when a patient, family member, or attending thanked me for being a good doctor. There was the catastrophizing teenager who assured me I had calmed his fears about his prognosis. Multiple children of old and sick patients in the hospital expressed appreciation for how I conducted family meetings, answered their questions, and grieved with them. And my heart just melted at the way the mother of a newborn with Neonatal Abstinence Syndrome called me "Dr. Kristen." I hope most of these memories were left out of the jar more out of concern for my patients' privacy than because of exhaustion. I did collect encouraging feedback from my superiors to come back to when something goes wrong, or I (inevitably) fail at some task:

"Thanks for all your great work on neurology. You have great attention to detail even working overnight as a guardian angel of neurology. Hope you will get some good rest after your overnight."

"You have good clinical judgement." (From none other than the guy who literally wrote the textbook on pediatric clinical diagnosis.)

"Special thank you to you for always going the distance: your willingness to step up in a lot of ways from this project [on reducing burnout] to your [history of medicine] noon conference and the stuff from this morning [sitting up front at Chairman's Rounds after an overnight shift in the pediatric emergency room] is inspiring!"

"I just wanted to let you know that you did a great job this week. The patient that you saw today was very complex from the ID standpoint and you did an exceptional job of collecting all of the information and putting it together in a coherent fashion with an excellent plan. I usually try to come up with some critical feedback but you really did an exceptional job and I can't think of anything specific for you to work on."


In other news, I was made a Yelp! Expert and have had two of my reviews featured as Reviews of the Day. My Yelp! account is another repository of memories from the past year, from the sketchy froyo place in Shadyside (Happy Berry) to our marvelous 12th anniversary dinner (Altius).

Now on to the Rememberlutions jar. It is not big enough for all my good memories: there was a whole stack of programs in addition to the tickets and scraps of paper stuffed inside. Here they are, in approximate chronological order:

We started the year by using our new Carnegie Museum membership to visit the Art Museum to see Brazilian artist Helio Oiticica's work.

Then there was a Duquesne University studio production of local faculty musicians performing late-19th-century French, Weimar-era German, and mid-20th-century American cabaret pieces called "The Art of Cabaret."

Probably my favorite musical performance of the year was the organ and vocal concert "Choral Fantasy" at East Liberty Presbyterian Church in January 2017. The melancholy sounds of the singers' voices drifting down to us from the balcony still haunt me.

Watching Hidden Figures with a group of Black women leaders in Pittsburgh.

Any year that includes Dale Chihuly glass is a good year. (Columbus, OH)
Other criteria: good food, fun games, beautiful music, friends and family.
While playing a pre-show ice-breaker game before a WordPlay performance at the Bricolage Theater (like The Moth, but with a live-DJed soundtrack), Dear Husband and I (Delilah) met Mary (Sampson), who invited us to attend the 19th annual Summit Against Racism at the Pittsburgh Theological Seminary, which she was organizing over MLK weekend. I later went back to the Seminary to watch "Unfinished Business: From the Great Migration to Black Lives Matter," a documentary about Pittsburgh's Black community.

The Pittsburgh Opera's Pennsylvania premiere of As One, a two-person operetta about a transgender woman's coming to terms with herself, had some of the best music for string quartet I have ever heard.

A "Welcome to worship card" from Third Presbyterian Church with the verse, "Jesus spoke to them saying, 'I am the Light of the world. Whoever follows me will never walk in darkness but will have the light of life.' John 8:12"

Beauty and the Beast, which was beautiful to watch but involved so much CGI that it wasn't really an improvement over the original cartoon version

Nefarious, another of our favorite new games this year.
Woody's Order, a one-woman show about the play-write and actor's older brother, Woody, who was born with cerebral palsy and "ordered" a sister from his parents. At the Pittsburgh Playhouse.

Pilobolus' Shadow Land at the Byham Theater, a review of which I combined with some of my own nocturnal dreams at the same time: What Dreams May Come.

A worship concert, "The World Beloved," at First United Methodist Church, one of our three faith communities.


This hand-written note from the Chair of the Pediatrics Department that came with a gift card to Millie's Ice Cream: "Have a couple of scoops on us. I am so grateful for your hard work and caring ways! Best, Terry" (Everyone got one, but still.)

At some point I went back to the Bricolage for WordPlay and played a game of bingo that involved finding someone who had never attended one of these shows and someone who had hands larger than mine. If I can, I like to attend on Friday nights, because the American Sign Language interpreter is really good.

Visiting the Museum of Fine Arts in Boston with friend FN while there for a conference in April.

I completed two jigsaw puzzles this year, one of a Bengal Tiger by myself (click for photo and short story), and one of the constellations and zodiac with my family over Christmas.

Treasured memories from our trip to Copenhagen and Scotland at the end of May so I could give a conference paper include walking on the beach in Aberdeen and touring the grounds of Balmoral Castle, Scottish Home to The Royal Family. Most interesting tidbit: watching Queen Elizabeth age from a perfectly ordinary-looking young wife and mother in their early photo Christmas cards to the wizened, white-haired old lady as I have always known her. We had actually attended church with her that morning(!). Also riding the funicular part of the way up Cairngorm Mountain and then hiking to the summit.

I gave the first Pediatrics noon conference for the new interns, a history of medicine talk about using food as medicine.

Staying up late on a work night to watch Moonlight with our "friends": someone shared to a list-serv I'm on that there would be a viewing of the film at a local theater, so we showed up, only to discover that it wasn't a public event at all: the owner of the theater had invited people he knew to his "home" to see the movie projected on a large screen over the stage.

Celebrating my birthday with dugout seats from one of my residency programs that were close enough for the Pirates Parrot to wiggle his butt in our faces.

Of all the game nights with L & R, apparently my favorite was the time we played the ever-expanding game of Concept. Second favorite: Carcassonne. Third: Starfarers of Catan.

The Pittsburgh revival of In the Heights, the Tony-Winning Best Musical by Lin-Manuel Miranda advertised with his picture (but a different lead actor in the show). Heart-felt but not particularly memorable for me.

Laughing our butts off from the cheap seats at An Act of God, an irreverent religious comedy written by a former Daily Show writer for a local comedian. Unfortunately, the home-town crowd appeared to have found ticket prices too high, and they ended up closing the month-long run 3 days early, before we could recommend it to anyone else.

Attending "On Green Dolphin Street," the September 2017 Jazz at Emmanuel vespers service


A note from friend JR, who hand-made my new Halloween earrings in the shapes of candy corns, spiders, and pumpkins: "Dearest Kristen, I hope that this week is going better for you. I also hope that you enjoy the earrings. I love and miss you and am always here if you need me." (I went as a Smarty Pants for Halloween; those are Smarties stuck to my pants with double-sided tape.)

The Carnegie Museum of Natural History's Power of Poison in the Natural World exhibition. I should get around to writing that blog post... Did you know the Mr. Yuck sticker was invented at the Children's Hospital here?

Then there's the program from the jazz concert by our neighbor at a suburban Presbyterian Church containing the following written conversation: Me: "We need spinach for Cajun chicken." DH: "We also need to cook rice." I guess that's what we had for dinner, which reminds me, I should post the recipe sometime, as it's one of our favorites.

Watching Murder on the Orient Express over Thanksgiving.

A ticket the Pittsburgh Symphony Orchestra's superfluous and mildly offensive mini-operetta staging of Haydn's Creation. The music by itself was worth it, however.

Probably my favorite theater experience was Dodo, an "immersive" theater experience put on by The Bricolage in the Carnegie Museums of Art and Natural History after hours that began as a surrealist comedy and became a meditation on memory, loss, and preservation.

From the jar I also retrieved a ticket to see Rogue One at Christmas 2016 (we later re-watched it with FUMC friends over dinner) and our stubs from a community theater production of The Music Man back in November 2016. Big events from 2017 that didn't make it into the jar included a c-c-c-cold visit to Fallingwater and a warmer one to Columbus; hearing the Junior Mendelssohn Choir sing and also the Bach Choir's War concert; going to Kennywood amusement park and tubing down a crick with my pediatrics colleagues; planting trees with the Pittsburgh Redbud Project and wandering Main Street in little Cambridge, Ohio, all decked out like a Charles Dicken's novel (blog post coming!).

Happy New Year, Reader. What are you going to remember about 2017?