Monday, July 29, 2019

What Residency Looks Like LXVII: Pimping

[Image description: A pair of eyeglasses rest on a printout of a Commentary essay entitled "The Art of Pimping" next to a bowl of summer salad.]

Sometimes residency looks like eating lunch while reading the classic tongue-in-cheek essay about pimping--the practice of a senior physician or surgeon riddling more junior medical or surgical trainees with questions "like a Gatling gun." It was written by a graduate of my program 30 years ago and makes fun of the psychological games everyone in the medical hierarchy plays when they feel the need of enhancing their own status at the expense of someone else.


Saturday, July 27, 2019

That's So Pittsburgh: Picklesburgh

Saturday Dear Husband and I headed downtown to the Roberto Clemente Bridge (one of the yellow "Three Sisters") for the Picklesburgh food and music festival. It celebrates the legacy of Henry John Heinz (1844-1919), childhood garden-produce entrepreneur, whose first product was horseradish but whose most famous is probably ketchup, "the taste loved 'round the world."* Did you know that Brits eat so much baked beans because of HJH's marketing prowess? Pickles were definitely among the 57 varieties of condiments in his warehouse when Heinz coined the slogan in 1896.

We attended with, oh, about a thousand of our "closest" friends and neighbors on a hot, sunny, late July day. DH was grateful for scoring probably the best garage parking spot we have yet enjoyed in the Cultural District. Skipping the kiosk for wristbands for alcoholic drinks, we ended up starting at the Geico tent, where I guessed at the number of stuffed geckos in a container. (I entered 73, and then after I submitted it, their logo said they were celebrating their 75th anniversary, so I bet that was the correct answer.). Then I rolled some big dice and "won" myself a tiny stuffed gecko. First food was carnitas sliders from the Warren Bar and Burrow. They consisted of a hunk of meat on a tiny bun with a very acidic pickled green tomato, a dill aioli, and a pickled mac and cheese on the side.

While eating in the breeze overlooking the Allegheny River, we listened to the announcer call a heat of the pickle juice drinking contest. At one point he alerted the other contestants that they could stop drinking since a winner had already been declared...

We continued onto the bridge, where thick streams of people shuffled alongside each other and a row of vendors hawking everything from pickle-themed jewelry to gutter-management systems, bottles of potable pickle brine to "I'm a big dill" tshirts, pickle-flavored ice cream and pickle-flavored beer. DH wanted a non-alcoholic drink, so we stopped by a kimchi tent to buy a glass of strawberry lemonade. I was still hungry and braved the "jumbo peanut butter pickle cookie" (above left), which tasted like a sugar cookie with a pickle aftertaste. There were little green bits of pickle in the cookie. We bypassed the Heinz photo booth where families were getting their picture taken with pickle and gherkin cuts, but I collected a Heinz pickle pin from a volunteer. That is the essence of modern consumer culture: convince people that advertising for your company is a privilege. (See also, a certain stuffed green lizard.)

We did not stop at Grandpa Joe's Candy Shop, but I did take a picture of the signs advertising Pickle Salt Water Taffy, Pickle Oreos, Pickle and Ketchup Soda, and Pickle Cotton Candy. On Monday while I was wrapping up, another resident stopped in the lounge to print something. She had her son with her (5-6 years old), who made a beeline for me--do you think he could smell the pediatrician in the room?--and peppered me with questions until I agreed to try some of his pickle cotton candy, which was...interesting.

When we had walked to the end of the bridge, it took another 5-10 minutes until we could get past the no-alcohol-beyond-this-point gate and turn around to walk back across the pedestrian part of the bridge. It's such a big bridge that you can't hear the music being played on either shore when you're in the center. Later that day the bridge got so full that the police started restricting access to alleviate the crush. Writing this on Monday night, I can easily imagine the carnage that would have resulted if a gunman had chosen this specialty food festival to shoot up rather than the garlic one in California. The inhabitants of this city have already proven that they are "Pittsburgh Strong," and while we pray for the people of Gilroy, most of us had hoped that ours would be the last mass shooting. They're funny that way: Pittsburghers will swelter to poke fun at themselves with a street fair devoted to cucumbers in vinegar, and they'll also show up to help a neighbor or protest injustice. That's so Pittsburgh.

*Pittsburghers so love Heinz ketchup that when someone found out that local amusement park Kennywood tried to stock Hunt's ketchup, an online petition tracked their outrage to the tune of 8,500 signatures, and the Heinz ketchup was brought back.

If you liked this edition of That's So Pittsburgh, you might like this post about a clever exhibit hiding in plain sight at the airport, or this one about the artistic legacy of another of the Steel City's Robber Barons.

Sunday, July 21, 2019

Happy Ice Cream Sunday!

On this National Ice Cream Day (the third Sunday in July), I present to you two portraits: one of me with chocolate ice cream in my face, and one with it on my face. This was the ridiculously large and unwieldy waffle cone I got at PNC Park after the rain delay Saturday night. It's got to be 5 scoops of ice cream: 2 in the cone and 3 placed precariously around the edges. Dear Husband got cookies N cream in a cake cone, which the server had the good sense to stack upright, given how quickly we had to lick them to keep ahead of the melting in 90+-degree heat.

Saturday, July 20, 2019

2019 Birthday Blast

This year our birthday celebrations lasted an entire week. The Saturday before, our respective parents drove into town for a meal of country-style ribs with homemade Asian peanut sauce (below), corn on the cob, green bean salad, and Dairy Queen ice cream cake--served on our best Mikasa china, of course. The next day Dear Husband played a splendid organ concert at St. Paul's Cathedral Church, and we celebrated some more with dinner at Alexander's Italian Bistro. The portions were so large that the two of us are still working our way through the leftovers.

His parents brought with them the "new" 2011 Buick Regal he had purchased from one of their neighbors a few weeks ago, as his old 2004 Chevy Malibu won't pass inspection this month.

On his actual birthday I had a little window in the afternoon to sneak away from the hospital for ice cream cones before finishing my notes and attending back-to-back dinner meetings.

On my birthday, I worked in both the hospital and the clinic, coming home in time for dinner. Then we cleaned up for a couple friends to come over to play Bananagrams and eat snacks.

Afterwards we opened cards and presents. We were blessed this year with many electronic and analog well-wishes. Our "haul" included a new suit for DH, a photograph of him in it for my future desk, another Pittsburgh Bits and Bites tour, a glass-mosaic flower pot, some lotion, and "mad money" that will probably go toward the cost of putting new tires on the Buick. The most unexpected and memorable gifts were original LIFE magazines from the months of our birthday, courtesy of out financial planner (?!).

Finally, Saturday I baked myself a strawberry cake with strawberry cream cheese frosting. Jenna over at Butternut Bakery convinced me to give up the (boxed) yellow cake with (dark) chocolate frosting and rainbow-colored sprinkles Birthday Cake I have had pretty much every year for as long as I can remember in favor of strawberry cake with strawberry cream cheese frosting. Although July is a little late for strawberries, this might have to become the new Birthday Cake. The cake itself is easy enough to make and comes out not particularly sweet. But the pink frosting has 3 (or 4!) cups of powdered sugar and covers up a multitude of sins, including one slightly burned edge. That's me pureeing strawberries while watching Fantastic Beasts and Where to Find Them: The Crimes of Grindelwald next to the recipe.

That night we had residency tickets to the Pirates vs the Phillies baseball game. On the way, we had to get around not one but two cars stopped in the middle of the road. The weather was SO. HOT: 104 with the heat index. It was too hot to sit outside, nevermind exert yourself playing baseball. There were a lot of doubles, and kudos to the pitcher who later came around and scored. I wondered if we could tolerate it for a whole 9 innings, when suddenly the ominous-looking clouds that had taken up residence above the stadium opened up. Rain delay! We hustled up the stairs from our second-row seats to the concourse. Soon it stopped long enough that we could join the line for ice cream. The temperature briefly dropped before the humidity really kicked in. In the bottom of the month inning there was some kerfuffle about a stolen base and a interference call, and the people sitting around us let the umpires know that the Pirates were going win anyway, and couldn't they just "play ball" do that the last out would put us all out of our misery?

Alas, the misery was prolonged by a concert letting out at the same time, and it took us an hour to get out of the parking garage, which was enough time to compose this post on my phone. However, we did come home with two bobblehead dolls, as the family next to us didn't need four of them.

Can you spot my new little flower pot with a drooping baby spider plant in it?

Sunday, July 14, 2019

What Residency Looks Like XLVI: beep BEEP BEEEEEEEEEEEEEEEEP!

Sometimes residency looks like being on call 24/14--as in, 24 hours a day, 7 days a week, for 2 weeks.

Sometimes residency looks like trying not to go stir-crazy by leaving the house at least once every day while also having to be ready to report to the hospital within 1 hour.

Sometimes residency looks like getting dressed every morning as if you were going to work--and stashing a pair of scrubs in the car, just in case.

Sometimes residency looks like the strange utilitarian calculus of trying to accomplish as many tasks as possible that would not be catastrophic if they were interrupted by a sudden call to come in to work a shift.

Sometimes residency looks like going to bed on time every night, because you know that the interns sign out at 6am, so you might be getting paged at 5am.

Sometimes residency looks like wrapping your pager in your towel on the side of the pool in case it goes off in the middle of swimming laps.

Sometimes residency looks like checking that your pager sound is on and the battery not dead because it hasn't gone off all weekend (no morning report or noon conference pages on Saturday or Sunday!).

Sometimes residency looks like letting your cat "hold" your pager, because you are so tired of having it on your person.

Sometimes residency looks like having the best first jeopardy that any of the chief residents can remember--because the one time another resident called off, you had clinic, so they asked the resident on second jeopardy to come in instead.


Saturday, July 6, 2019

Devastatingly Beautiful Memoir about Love, Intellect, and Disability

Image may contain: 2 people, people smiling, people sitting, table and indoor
Photo from A Life Beyond Reason's Facebook page. I do not own this image.

I have just finished Chris Gabbard's book, A Life Beyond Reason: A Father's Memoir (2019), and I am absolutely devastated. Gabbard describes the birth, life, and death of his son, August, and how August's impairments and disabilities changed Gabbard's outlook on everything from fatherhood to living with a disability to modern medical science to the Enlightenment to his belief in God (or initial lack thereof). While I found the writing somewhat thin at times--perhaps because it is intended for a general audience rather than literature professors such as himself--Gabbard tells August's tale, which begins and ends with medical malpractice, through his perspective as an atheist and an intellectual, with flashbacks to explain how he came to hold various beliefs. A birth injury, for which Chris and Ilene never successfully sued, left August with cerebral palsy and spastic quadriplegia. In his father's eyes this made August "monstrous" in the medieval sense of inspiring awe and (eventually) connection with the divine. In the eyes of many others, unfortunately,  it made him "monstrous" in the Enlightenment sense of defying nature, to the point at which some people could not bear to even look at August.

Perhaps most curious (or frustrating) to me as a medical provider and one who wants to work with the CP population is Gabbard's habit of not naming names--hospitals, doctors, and especially the medical device company that made the intrathecal baclofen pump that was promised to make everything easier but finally broke both August and his father's faith in medicine. I assume this was a legal recommendation. In addition, Gabbard spends a considerable part of this short and effective book rehashing the electronic fetal monitoring (EMF) of August's birth, which indicated fetal distress but was dismissed by overworked and/or overly optimistic birth attendants. But he never comes out and says that retrospective studies have shown that increased fetal monitoring has increased the rate of Cesarean sections to 33% of all births but has not changed rates of cerebral palsy (1:500 live births). Perhaps as much as 70% of CP comes from prenatal causes. Nevertheless, after two nonreassuring fetal stress tests, 39 hours of labor, and 12 days post-dates, maybe a Cesarean section would have prevented (more) damage. We will never know. It was more optimistic doctors (who may have had ulterior, career-minded reasons) who talked Chris and Ilene into implanting an intrathecal baclofen pump, although oral baclofen and Botox injections had not yet failed for August. Thus began his years-long death spiral of complications that ended abruptly with overwhelming pneumonia.

While Gabbard has grieved and will grieve for a lifetime over all this, I am still raw just from reading about it. What Gabbard wants us to know is that he is not sorry to have had the exquisite pleasure and pain of having been August's primary caregiver: waking him in the morning, bathing, changing diapers and clothes, hand-feeding, transferring from bed to floor to wheelchair to stander, and tucking him in at night. The two of them enjoyed each other, and August helped Gabbard realize that the high-intellectual tenets of his youth--namely Socrates' dictum that "an unexamined life is not worth living"--was a farce. Contra John Locke, the fact that August and Chris and Ilene and Clio and all the college students they hired as caregivers lived interdependent lives proved August's humanity. Along the way, Gabbard provides light disability theory and reviews a veritable who's-who of secondary literature on parenting a child with a disability and on modern medical practice.

I can recommend this book to a wide variety of readers, from curious laypersons to self-interested caregivers, and from pre-health-professional college students to practitioners in fields such as pediatrics, rehab medicine, and all the therapies.

Editor's Note: The book author is a colleague of an old friend from graduate school. I don't think this biases my judgment but does make me grateful I found out about the book so soon after publication!