Merry Christmas 2019!

First Week of Advent

The first Sunday of Advent was quiet this year, as it fell right after Thanksgiving. (I spent the same weekend last year visiting family in New Jersey and getting stranded an extra night due to weather out of Newark.) Since I was on elective, I took a vacation day in the middle of the week to  catch up on various tasks. In the evening we called up of friend JWW so DH could shoot the breeze and steal candies while I iced a pre-made gingerbread house. The annual church mouse decoration is called "Mice-tro" this year, and she conducted the corn-husk creche people in Christmas caroling in front of the gingerbread house (right). (You can follow the carolers from creche to creche in this blogpost from Dear Husband.)

Friday evening after work, Dear Husband and I drove downtown smack into Pittsburgh Penguins traffic, in order to attend a departmental holiday party. We were the second couple there. Awk-ward. Eventually there were enough people whom we knew that we could move from small talk to actual conversation over a good buffet dinner. We helped get the dancing started ('natch) but left once my knees started talking to me (ouch).

Saturday morning we bought a Christmas tree and decorated the house with lights outside and creches inside. We had a tradition of "hunting and killing" of own fir tree while in Illinois, and at first we tried to do so in Pittsburgh, but due to increasingly dissatisfying experiences I threw in the towel and resigned us to a hardware store tree. However, they were short, overpriced, and in poor condition. Thankfully we had passed a sign for a guy selling "Christmas trees for Veterans" who talked our ears off and let us leave the lot with the tree to get cash from an ATM to pay him. Having been cut down and trucked in from Indiana, it sheds more needles then DH would like, but it's tall, full, and shapely. We trimmed it while watching A Christmas Story. (I had forgotten how racist the scene in the Chinese restaurant is for making fun of the stereotype that East Asians say "r" instead of "l" and think that broadcasters should cut it, especially as it does not advance the plot.)


Saturday afternoon DH and I attended a Messiah sing of an abridged version of Handel's Messiah at Calvary United Methodist Church. We bought the score and grabbed available seats in the soprano section, although we are a bass with perfect pitch and a limited-range, nearly tone-deaf alto. The sanctuary was beautiful, and the music was too (except the cellist, who was repeatedly off key--even this nearly tone-deaf alto could tell). I sang along as best I could, until I choked up when the tympani came in during the Hallelujah chorus. Delectable cookie table afterwards.

Second Week of Advent

After another nice church service, we came home to finish cleaning house. We hosted a dinner Sunday night for prospective residency applicants, complete with festive music on the stereo and borrowed folding tables and chairs to accommodate everyone. I had driven to Ikea on Saturday to get official Ikea meat- and veggie balls and lindenberry jam to serve with green salad, bowtie pasta, and sugar cookies.

Work that week was not too busy, so Friday evening DH talked me into what turned out to be an utterly delightful Christmas concert at East Liberty Presbyterian Church (here's a preview video from YouTube!). It featured choir, organ, a brass ensemble, and local classical music radio voice Jim Cunningham reading "Twas the Night Before Christmas." No cookie table afterwards, and because we had taken the bus in order to skip the headache of parking in East Liberty, we filled the 20 minutes waiting for the return bus with DH's first trip to the Milkshake Factory to share a strawberry banana shake.

We missed another holiday party because DH was playing as guest organist at another church. Because call time was two hours before the concert, I let him drive on ahead while I did things at home. Then I took the bus halfway, stopping for a free scoop of ice cream (peppermint brownie in a waffle cone) for Elite Yelpers. I ate at a little table by myself while geeking out with a couple magazines: the tree edition of the Western Pennsylvania Conservancy newsletter, and a recent edition of the Annals of Internal Medicine, where I read the case report of the British teenager who suffered permanent vision damage due to vitamin deficiencies from poor diet (it was in the popular press in the fall). Then I walked the rest of the way to the church, arriving in good time for a beautiful candlelit service of choral music, handbells, recorders, strings, and DH on organ/piano. The cookie/hors d'oeuvre table was superior, as it always is at First United Methodist Church.

Afterwards we usually go out for dinner and drinks to Harris Grill, but 10 months after a fire, the Shadyside location is still closed. Shady Grove would course at 10pm, so I made a reservation at Hidden Harbor. While ordering our tiki drinks, however, we discovered that the kitchen had closed 10 minutes earlier, at 10pm. After a quick Yelp search, we ended up on the other end of Squirrel Hill, at Murray Avenue Grill, whose kitchen closes at 11pm, just 1 hour before the restaurant (unlike 3 hours before closing for HH). Food and drinks enjoyed by all, especially the dark hot chocolate with raspberry schnapps. (Here I am modeling the handwarmers a Bible-study friend in Dresden made for me, since I was always cold.)

Third Week of Advent

The next day it was pageant time at Third Presbyterian Church. Last year I played Female Parishioner #3 from my pew; this year I joined the Prophetic Chorus, a Greek chorus-inspired peanut gallery with snappy one-liners. The script was a thoughtful consideration of big things coming from backwater places (like Butler, PA, compared to Pittsburgh [see my travel blog about the home of the Jeep]). I made a version of my MIL's broccoli salad for the potluck (recipe here).

We went from there to the Irma Freeman Center for Imagination on VIP tickets to hear the East End Song Studio's December recital, Hearth Songs & Stories: From Generation to Generation. It involved kids and adults, both amateur and professional, playing piano and singing, as well as some InterPlay creative movement/improv exercises by Sheila Collins to keep things interesting. Special guest Betsy Riddle Ruderfer sang a whole set dedicated to the 1940s. The snapshot is of the finale, which included piano and drums!

At work in the pediatric outpatient clinic, every day had a holiday theme: cookie table, crazy holiday sweater, hot cocoa day, etc. Downstairs where there aren't any windows, we put up a 10-hour YouTube video of a crackling Yule logs, and it just seemed to warm up the temperature and the atmosphere.

Friday evening we attended a much-anticipated local adaptation of Dickens's A Christmas Carol, called "Yinzer Scrooged." (That's the Midnight Radio selfie station; DH: "I do so much for love.") It was presented as a radio play, with a few actors playing all the characters and doing the sound effects on stage. The writers had rewritten the story to be about the head of the largest hospital/ insurance system in the state of Pennsylvania ("Jeff-enezer Scrooge-off," aka my biggest boss). It was hilarious pointed social commentary that didn't seem quite appropriate for the elementary-age children in the audience.

Fourth Week of Advent

My last day of freedom before holiday coverage started I spent relaxing. First there was brunch with a friend's family, and then we all went to the Carnegie Natural History Museum. I had never seen the dinosaur exhibit before. Apparently it's the largest in the country, and all funded by Andrew Carnegie's money to a private paleontologist who went digging in the American West and found great treasure troves of fossils--right before the land could be made public parks and protected spaces. Perhaps the most interesting thing I learned from the fossils was the length of the sauropods' tails, which must have helped stabilize them as they moved; there was also an interesting early mammal (some kind of boar, I think), whose rib cage extended practically to its pelvis, suggesting a very large thoracic (lung and heart) cavity, but I supposed the diaphragm must have been quite concave, in order to make room for the digestive organs protected by the armor of the ribs. There was also a very interesting National Geographic photography exhibit.

Next it was on to some other friends' house to hang out until it was time to go to "The Muppet Christmas Carol." It was the first time either of them had seen my favorite Christmas music! Then I
holed up in a call room for a couple of hours of work/relaxation on my laptop before a stretch of six night shifts at the Children's Hospital. The hospital is decked out in holiday swag--mostly for Christmas, some for Hanukkah, none for Kwanzaa--and so are the staff. For Christmas Eve the night residents had a "holiday potluck" that included rotisserie chicken, homemade mac'n'cheese, and a black-eyed-pea salad I made for good luck in the new year. (I swapped white onion for the scallions my grocery store didn't have, and omitted the spicy peppers.)

Christmas Day I woke up around lunchtime, so once DH had come back from noon mass, we opened presents around the tree before I went back to bed for a nap. Then we drove to the hospital to have dinner together. Unfortunately, we left 10 minutes late and then waited 15 minutes for someone to cook us a couple of Impossible Burgers (fancy!), so we had to rush to eat in time for me to go upstairs of signout. When I finally got off after the last shift, we packed up and drove to Cincinnati to celebrate with my in-laws.  I napped in the car.

Although there was deli meat we needed to eat, DH surprised me with a stop in Zanesville, OH, at Tom's Ice Cream Bowl, which USA Today named the country's best ice cream shop back in 1998. With the exception of the jukebox now being a fancy touchscreen variety, it looks like nothing has changed in half a century. We skipped lunch in favor of ogling the excessively long lists of "seasonal" and "year-round" flavors. DH opted for cherry cordial in a waffle cone, while I had the peppermint with hot fudge. We think we'll stop by again on our way back to Pittsburgh before New Year's.

In Cincinnati we exchanged gifts and treated DH's parents to dinner and a movie, A Beautiful Day in the Neighborhood, which is not a biopic about Fred Rogers (like last year's documentary, Won't You Be My Neighbor?) but rather a semi-fictionalized story using tropes from the children's TV show about learning how to manage negative emotions and still be family together. Later we played Ticket to Ride (Europe) with our niece and nephew. The only thing that would have made the trip better would have been if I had not come down with a cold. I think it was almost inevitable after 2 weeks of caring for sick children, and now that I'm off for a few days, I "have the time" to be sick. Just as long is it's gone when I start my next, in-patient rotation!


Editor's Note: That was a long post--thanks for sticking with it/us. Dear Husband and I are incredibly fond of all of you and encourage you to reach out by text, Facebook, email, phone, or in the comment sections of our respective blogs (click here for Pianonoise). We wish you Merry Christmas and a Happy New Year!

The Many Faces of Rosie Cat

While going through photos on Dear Husband's phone to find ones to use in blog posts about our vacation to California, I discovered a trove of images of our beloved cat, Rosamunda, from Advent/Christmas. Sometimes she posed with us or the holiday decor, other times she helped with the wrapping. We missed her the week we were gone, so I share them with you as a place holder until I can get our snaps sorted and posted.

What Residency Looks Like LXXXIV: Quote Board

The best and worst part about the practice of medicine is that it involves human beings, who rendered the following gems one month while I was taking care of adult patients in the hospital.

About an abdominal xray looking for intestinal obstruction, the radiologist wrote: "Normal or mild/early ileus." ...so is is abnormal or not?

Maxim in critical care medicine: "All shock leads to distributive shock." AKA a safe answer when being pimped about what kind of shock a patient is in.

Patient: "I could hear a rat pissing on cotton." So you had a quiet night, huh? That's pretty rare in a hospital.

Me to a patient: "I will call your son to let him know you are on the floor." (AKA out of the emergency room)

Her: "He's a 25-year-old guy. You have to tell him I'm not literally on the floor,"

Surgical team x2: "We'll take out his larynx and it [aspiration] will no longer be a problem."

Us: That's a mighty big sledgehammer you're wielding there.

Me: "In Medicine we rely on the history 80 of the time."

Consultant: "In Dermatology we rely on physical exam 80% of the time." They apparently trust their own eyes and pattern recognition over any patient's ability to describe what their skin looked like yesterday, much less last week.

Radiologist: "Could the patient possibly have swallowed a tooth?" When the patient was well enough I later asked him, and yes, he thought he might have done.

Night team: "If you ever do this to me, I swear I will come back and haunt you." About a very old and frail patient being re-admitted again.

Radiologist reading an xray ordered "to check placement of PICC line": "No PICC line."

Radiologist about a chest xray: "Pleural effusion occupying 3040% of lung."

Patient: "If I'm going to die, you'd better call my wife and my baby mama." Reader, he did not die.

?Attending: "I got an iced coffee, 'cause it's special to me."


Editor's Note: This month's rotation also brought the random guy in the waiting room googling symptoms for a second opinion, and RAINBOWS.

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Throw-Back Thursday: Reading in the Hot Tub

Yes, this photo shows me reading a book while sitting in the hot tub with my family at our rental cabin toward the end of our week at Smith Mountain Lake in August, when the weather had turned from blazing hot to mild.

Books don't read themselves!

As it happens, the review I wrote is being published this month in an academic journal. I'll always remember this one fondly.

What Residency Looks Like LXXXIII: It's not brain surgery

I used to want to be a neurosurgeon. Growing up in Baltimore City in the 1990s, when Benjamin Carson would give inspirational talks to school children about doing well in school, I thought I wanted to grow up to replace him at Johns Hopkins. It was the hardest job I could think of, and I liked the approbation from adults when I told them this.

When I got older, a good family friend advised that I wouldn't like myself by the time I finished neurosurgery residency and that I should find a specialty that was more accommodating to women. I had always wanted to work with children, especially those with special needs, so in college I entertained the idea of going into developmental and behavioral pediatrics. In medical school I learned that DBP is more of a consult field, whereas I still cherished the idea of developing long-term relationships with patients and their families around all issues, especially those around access to resources such as community supports, education, and jobs. Very late I discovered the fields of transitional medicine, which helps teens graduate into adult clinics, and complex care, a niche for taking care of children and youth with special health care needs. These are growing fields, as more babies survive the Neonatal Intensive Care Unit (and later, the Pediatric Intensive Care Unit) to grow into young adults who carry diagnoses such as developmental delay, intellectual disability, Autism Spectrum Disorder, or cerebral palsy. They might use a feeding tube, a breathing tube at night or all the time, a walker or wheelchair, a communication device or sign language, and a variety of other technologies and accommodations seen and unseen.

This is an accurate representation of me
in the OR during a neurosurgery case.

One medical advance helping this population is the shunt, a plastic tube that drains excess cerebral spinal fluid from around the brain into the heart, chest cavity, or abdominal space. There's a joke in pediatrics that goes, "It's not the shunt." That's what the neurosurgeon stereotypically says when consulted about whether a headache or infection could be due to shunt malfunction or infection. In their experience, the shunt is almost never to blame. I wondered why. In order to be a good primary care doctor to patients with shunts, I signed up for an elective rotation with the neurosurgery team. In clinic or on the wards, I shadowed the other providers to hear the kinds of questions they asked, and in the operating room, I just watched at first.

Then the fellow got me a pair of official scrubs* so that I could "scrub in" to surgery to stand closer to the table. After I was scrubbed in, they let me help:

- I programmed a shunt (it involves a fancy magnet).
- I held instrument cords while the surgeons and techs got everything into place.
- I either stepped on the electrical knife pedal or pointed it out to the attending. (It was the round one.)
- I cleaned bits of brain tumor off of the fellow's instruments.
- I held my finger against a hole in the patient's skull to prevent cerebral spinal fluid from leaking out. (I felt like the little Dutch boy with his finger in the dike.)

I mean, I wasn't doing brain surgery. But I appreciated the surgeons' willingness to let me tag along to see how their perspective differs from mine. The point of electives in medical school and residency isn't to master that field, it's to get a better appreciation for it and to pick up a few tips and tricks so that I will be a better consultee. Plus, doctors and surgeons are human too, and we all prefer to work with and trust people better when we know them, so I felt like I was doing a sort of cultural exchange program to built bridges between the pediatricians and the neurosurgeons.

All in all, it was a successful elective. I can't stand the early hours of surgical and hospital work, and I wonder whether I would have ever built up the appropriate dexterity for surgery, but I will be a better doc now that I know it's not the shunt!


*A few years ago the children's hospital changed their OR scrub color to what I once overheard a surgeon describe as "Cookie-monster blue."

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What Residency Looks Like LXXXII: Happy Friendsgiving!

Sometimes residency looks like a dozen Med-Peds residents and fellows, assorted significant others, a dog, college football on the television, and waaaay too much food. We had a 17-pound turkey, stuffing, mashed potatoes, homemade cranberry sauce, sweet potato casserole, roasted Brussels sprouts and cauliflower, two versions of green bean casserole (one vegan), green salad with pomegranate seeds, deviled eggs, Chinese dumplings, rolls, biscuits, herbed spinach-stuffed bread, spicy chili dip, pumpkin pie, mixed berry pie, a divine chocolate cake, chocolate bark, candied walnuts, chocolate-covered gluten-free waffles made out of pretzel dough, wine, beer, and whiskey. Needless to say, no one left hungry!

While people floated in and out of the kitchen for dessert, there was a rotating Bananagrams game.

Also plaid. There was a lot of plaid.

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What Residency Looks Like LXXXI: Acts of Kindness

Since 1998, November 13 has been celebrated as World Kindness Day in an attempt to create a better world by promoting good deeds and acts of kindness. Our local PBS and NPR affiliate, WQED, linked its celebration to Mr. Rogers, who filmed his famous children's show in their studios for decades, as a way to premier an interactive mixed-media exhibit about Fred Rogers by artist Wayne Brezinka entitled "Mister Rogers: Just the Way You Are." In response, my residency program challenged us to wear cardigans today.

Here's a photo of me and one of my colleagues, who had just given his senior talk about pulmonary hypertension in patients with heart failure. The kindness I did was to come early, sit in front, and take notes, so he didn't feel like the large amount of work he had put into his talk was wasted in a half-empty auditorium.

“There’s no person in the whole world like you, and I like you just the way you are.” ~ Mr. Rogers

What kindness did you do today?

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What Residency Looks Like LXXX: Smile!

Sometimes residency looks like teaching first-year medical students how to perform a physical exam, including mnemonics to help remember where to listen for murmurs on the chest, and the order in which the heart valves close.


These are the heart valves (an oldie but a goodie):
All = Aortic valve
Physicians = Pulmonic valve
Take = Tricuspid valve
Money = Mitral valve

This is the order in which they close (I wrote this one!):
My = Mitral valve
Teeth = Tricuspid valve
Are = Atrial valve
Pretty = Pulmonic valve

And then you smile, because you got it right!

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What Residency Looks Like LXXIX: Yolk, yolk, yolk

Sometimes residency looks like wearing a punny costume to the hospital on Halloween, modeling it in the hallway for your webcam, and then taking it off in the afternoon when you have job interviews(!). You probably can't see the "paprika" red marker specks on the yellow tissue-paper yolk; it's been affixed to a white oval of paper. I have to attend a residency recruitment dinner tonight, or else I would have cajoled Dear Husband into wearing a tan outfit with my old halo, and going to a friend's house as angel food cake.

Editor's Note: Past costumes can be found here and here.

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What Residency Looks Like LXXVIII: Chew on this

Sometimes residency looks like a big smile before you start your senior talk on a controversial anti-dieting movement, only to realize that the latest version of the slides did not get saved in the cloud, so now you have to use an older version without all your nice edits, and then you wonder whether nobody will answer your easy open-ended question at the beginning because they disagree with you or because they saw you fumble and think you are incompetent. Except by the end of the talk you're running on time after all because you didn't have to try to power through all those extra slides you added last night, and in fact the audience is interrupting you to ask questions and make more comments and coming up afterwards excited to know your opinion, so maybe it wasn't such a disaster after all.

Title: "Health At Every Size: A Historical and Literature Review."

Best of all? I get a re-do next week at a different site. I might cut those extra slides, though.

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What Residency Looks Like LXXVII: The View from the Top

Sometimes residency looks like a gorgeous view from the research center, where you have stopped for an hour to fight with PowerPoint between clinic and a meeting. The children's hospital opened 10 years ago on a hill near the Allegheny River in the north-central Pittsburgh neighborhood of Lawrenceville, which used to be a grimy area that has since gentrified with twee shops and apartments (but the only grocery store is still a SaveALot). Looking across the river valley walking into or out of work here is one of the highlights of my days on pediatrics. The fall colors are brief but brilliant, and the snowy hillsides never fail to remind me of Dresden and the Elbe. Sometimes there is too much fog to see anything, other times lights twinkle in the dark. Today, the clumpy white clouds doubled the still-green trees on the hills below, seen over the rooftops of nearby Bloomfield, the old Italian neighborhood.

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What Residency Looks Like LXXVI: Snugglepuss

Sometimes residency looks like snuggling with your kitty while reading scientific articles. I was preparing for my senior talk, an hour-long lecture that graduating internal medicine residents give to answer a clinical question. Mine was, "Is there scientific evidence to support the anti-dieting movement called Health At Every Size(R)?" Rosamunde kept me company while I took a deep dive into the studies.

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The First Time I Cried When a Patient Died

Dear Patient,

"No show." Those two little words usually mean someone forgot their appointment, or couldn't find a ride, or changed their phone number and didn't get the reminder call. So I was offended for you when I looked up in the middle of clinic to see that you had been marked as a "no show" for your hospital follow-up with me. I had gone over your chart the night before and walked into clinic happy to start a busy afternoon with a friendly face, only to find out that you had died the day after you were discharged from the hospital two weeks earlier. Because it happened outside of a healthcare setting, there was no documentation in the computerized record that status asthmaticus had sucked the life out of you.

You, who came to me when you felt a lump and needed to know whether it was breast cancer. You, whose roommate kicked you out for fear of getting sick from your chemotherapy and radiation. You, who survived so many complications until you could finally get your bum shoulder fixed. You, who sounded so agreeable on the phone when I reminded you after your pre-op visit that if you could find the money for it, an inhaler would help with your trouble breathing. I thought you needed one, at least while the weather was changing.

When the clinic manager told me you had passed away, I hoped he meant some other patient. Maybe you would have laughed self-deprecatingly when I told you I dropped everything I was holding in order to channel all my energy into standing upright in his office rather than crumpling to the floor. As he stood up to hug me, I don't think he thought I was the kind of resident to cry at a patient's death. Maybe I didn't either, since I had never done it before.

I had seen patients die of cancer and of overwhelming infection. There was the middle-aged man I was sure I had killed with too much Valium for the seizures from the tumors in his brain, whose mother's vitriolic comments after his death surprised even seasoned ICU nurses. I tried to get closure around the woman whose fingers and toes were black and gangrenous from the blood pressure medications needed to keep her heart pumping, whose husband let her go on my one day off. I have done CPR on children we knew were not going to survive, including a baby whose mother tried so hard to get pregnant and then fell asleep with her on the couch. I was able to collect myself after those deaths. But for you, I put my face in my hands and sobbed.

Was it because of the shock of expecting to see you and then realizing I never would again? The injustice of surviving cancer only to succumb to a treatable chronic condition? The fact that you were only a few years older than me? Or that despite proudly being "[your] doctor," I had not been able to keep this from happening during the peak time for asthma attacks?

When I left clinic at the end of the afternoon, I stopped by the clinic manager's office again. He asked how I was doing, and he remarked that caring for patients is what makes medicine and nursing so hard. He is right, but I also believe that caring for you made being your doctor easy, because it was less of a job and more of a calling. Maybe it is better that I missed the funeral and will always remember how vivacious you were at our last appointment, complaining that the surgeon had not prescribed you enough pain medication.

Later I realized some of my tears may have been from anger: that no one called your primary care provider after declaring your time of death. That the chart did not alert me to your status as a "deceased patient" when I was preparing for clinic between a long day at the hospital and a few hours of sleep. And that the electronic medical record does not have a designation for "a patient who cannot keep her appointment because she could not afford a life-saving medication."

Sincerely,
Your Doctor

This is What Residency Looks Like LXXV. You can find the previous post about CPR training here. The next post, about the view from the children's hospital, is here.

Portland: Marathon

As you may have read, Dear Husband accompanied me to Portland, Oregon, for a combination working vacation. After a few days of sightseeing together (e.g. here), I attended an academic conference, while he kept himself occupied in the hotel or around town. On Sunday morning, I played hooky from the conference to watch him run the Portland Marathon, which fortuitously was scheduled for the end of our trip.

Post time was 6:30am, so we woke up early, dressed warmly and scarfed granola bars for breakfast before walking 6 blocks or so from our hotel to the staging area. DH gave me his extra layers and joined the throngs in the chutes at the last possible minute. I watched the Unipiper pedal around on his unicycle wearing a kilt and a Darth Vader helmet, playing his bagpipe and shooting flames. The man is a Portland institution. Keep Portland weird.

By this point the sun had risen, and volunteers had handed out cowbells to spectators. I rang mine while following a map and the crowds to pre-determined spots to catch a glimpse of DH at various mile markers. I wasn't fast enough with my camera to get any snapshots, but perhaps my favorite moment of the race was when I cut through the crowd of runners to cross the street--and got to high-five DH as he ran by me! Then the course swerved out of downtown.

After this a good girlfriend from high school who now lives in the area met me back at the hotel. We went to a food truck for breakfast sandwiches that we ate in the room while catching up. Finally, it was time to walk across the river to see DH at the last check point before the finish line. I accidentally had my camera on selfie mode, which is how I captured DH's favorite pic of the race (left) of me enthusiastically cheering him on.

Then we walked back across the bridge and made our way to the final stretch, where I captured his photo of DH sprinting to the finish line. He made great time, setting a personal best of 4 hours 33 minutes to run 26.2 miles. We ate a bunch of free food in the celebration zone before R.L. kindly drove us to the airport to begin the long journey home. So long, Portland--it's been real!

Portland: Self-self-self portrait

Some of the panels at this conference were held on the 22nd and 23rd floors of the hotel. The views were stunning, but so were the crowds trying to cram into the elevators to get to or from them. I was running early during the lunch break and managed to have an elevator almost entirely to myself in order to snap this self-portrait with its receding mirror background.

It's That Conference Life

It's that conference life
It's that conference life
Scholar do or die
Scholar do or die
Directly from th'archives
Book sellas on the prowl
And the Chair
Oh oh oh
It's that conference life



(With apologies to Ms. Krazie, "Its that gangster life")

Editor's note: I have a chapter in this book, Becoming TransGerman: Cultural Identity Beyond Geography (Peter Lang, 2019).

Portland: Multnomah Falls

After lunch in Oregon City, we turned north and east, to drive into the Columbia River Gorge. There are a dozen waterfalls to visit as the water table confronts sharp drops in the limestone cliffs. With an eye to getting the rental car back the same day--and to preserving Dear Husband's legs for the Portland Marathon on Sunday--we chose the largest and most popular. At 620 feet high, Multnomah Falls is the tallest waterfall in the state of Oregon. Two million people per year park in the lots along the river, stop in the visitor center, and take the paved path to the overlook bridge. Fewer hike the winding path with 11 switchbacks over the ridge up to the observation deck. Below you can see the view looking west/downstream from partway up the path. Below that is the "Little Multnomah Falls" (not part of the official waterfall), snapped from the deck that is so high up you can't see it from the bottom, and where the water rushing noisily over the precipice to the right. Fun fact: on Labor Day 1995, a 400-ton boulder fell off the cliff face into the catchment pool, showering an unsuspecting wedding party taking photographs.

We hiked back down, ate a snack in the car, and then drove toward Portland, reaching Vista House on Crown Point just before it closed. Unfortunately, the day's warmth was rapidly rising, bringing in cold wind and clouds. I didn't even want to stand outside very long to take pictures, and the cafe had already closed, so we couldn't get warm drinks. We settled for perusing the small exhibit space, covertly observing a small band making a promotional video, and imagining how nice it would be to attend a fancy soiree on a warm night when the building could be opened to the stars.  

Once back in Portland, we returned the rental car, took the bus back to our neighborhood, and stuffed ourselves with Ethiopian food before falling into bed.