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. 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.

Upon more sober reflection, I realize some of my tears may have been in 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.

Portland: Oregon City

One day we rented a car to get out of Portland. First stop: Oregon City, which was the first capital of the Oregon Territory. Settled by a Mr. John McLaughlin of the Hudson Bay Company, it had the first courthouse west of the Rocky Mountains, which is why it was the end of the Oregon Trail (Dear Husband is sitting on the marker for the end of the trail). Not only did pioneers file their land claims there, but the original founding documents of San Francisco were also filed there. The town is crammed between some bluffs and the Willamette River (accent on the second syllable), eventually growing up and along both banks. 

This land was originally settled by the Clackamas and Kalapuya. They had a myth that two gods created the Willamette Falls by pulling a rope across the river. The drop is only 4 stories, but it is the second-largest waterfall in the United States by volume, behind only Niagara Falls. Because of all that hydraulic energy, the Falls became site of plants for timber, paper, wool, and electricity. Consequently, they are not scenic in the least, being surrounded by (mostly defunct) industrial buildings. There is a campaign to tear down the empty ones and build offices, homes, and a riverwalk instead. They reminded us of the theme of human interaction with nature from our Japanese Garden and Chinese Garden visits, albeit in the direction of making nature look worse rather than better.

 Although we stopped by the End of the Oregon Trail Museum in order to take pictures of the green and general store where pioneers typically ended their journey that had begun in Independence, Missouri, we chose to visit the decidedly less flashy Museum of the Oregon Territories, in an ugly little building from the 1980s across from the Willamette Falls. It was cheaper but offered 2 solid hours of education and diversion. The exhibits cover the earliest Native tribes, European settlement, natural resources as well as human industries, an old-time pharmacy display, and a rather thorough exhibit on early photography dedicated to both portraiture and documenting downtown Oregon City.

The blue globe is a hand grenade fire extinguisher. Yes, you read that correctly.

We also made a point of experiencing the United States’ only municipal elevator. It was originally built in 1912 of wood and required a 35-foot catwalk to get to the bluff across the railroad tracks. It was powered by water and took 3-5 minutes. There were a couple of scandals involved in its construction, including that Mrs. Clark didn’t want to sell the city access to her land, so they sued and won; the city also had to stack the water board in order to get access to the water system. As predicted, it significantly dropped the water pressure. In 1954, they rebuilt the elevator with steel and a tunnel under the railroad tracks. Now powered by electricity, the trip takes just 15 seconds each way. It’s completely free, and when we told the operator we were tourists, he gave us pamphlets and “I rode the Oregon City municipal elevator” stickers.

  

The building has a space-age feel, but it got a face lift just over a decade ago, with an old-timey map of the town on the floor tiles and lots and lots of holographic photographs on the walls that change depending on which angle you view them from. There were also helpful decals on the windows describing the views of Oregon City’s tiny but vibrant downtown and Mt. St. Helena and Mt. Hood in the distance. We used a coupon at Mesa Fresca for Peruvian/Mexican lunch before hitting the road. Destination: Multnomah Falls!

Portland: Washington Park

In part to adjust to Pacific Time, and in part because I wanted to see Portland instead of the inside of yet more buildings (the cabin fever of conferencing in a hotel set in early), I planned most of our activities to be outdoors. There are a number of parks in and around the city for walking/hiking, among them Washington Park on the west side, where the zoo, Hoyt Arboretum, a children's museum, Japanese Garden, and the famous International Rose Test Garden are located. There was hardly anything blooming this time of year in the City of Roses.

First we hiked up a residential hill in search of “Portland’s favorite tree,” a redwood that won the honor in a in the last popular election of the kind, in 1987. I had noticed a pin in Google Maps, but the GPS was slightly off that day, so we sort of cast about for several minutes until Dear Husband finally noticed the small metal plaque buried at the base of the trunk that declared this particular tall tree (and not the tall ones 50 feet away) as the supreme tree in a city that has many lining its streets and filling its green spaces. I didn’t get a good picture of its towering greatness, but this snarky blogger did.

Then it was on up the hill even further—DH: Pittsburgh, I thought you prepared me with hill training!—to Washington Park. Right there at the entrance is the Lewis and Clark column, donated by the good people of the states of Oregon, Idado, Montana, and Washington in 1903. It enjoys pride of place at the formal entrance to the park, but as monuments go, it’s one of the less ostentatious I’ve ever seen. 

Down the slope a little ways stands Sacagawea’s statue. She carries her baby, Jean-Baptiste, on her back and points west (away from the Lewis and Clark column, incidentally). Alice Cooper sculpted it on commission by the Committee of Portland Women for the Lewis & Clark Centennial Exhibition that was held in Portland in 1905. (This was earlier than I suspected--I assumed she hadn't been added until the 1990s.)

We continued deeper in the park to find the Oregon Holocaust Memorial, which may be one of the best (read: most accurate) I have ever seen. A brick path leads from a “European” streetlamp toward an arc of granite. It is strewn with discarded items in bronze: a suitcase, a violin, eyeglasses, a teddy bear, a baby shoe. On the memorial wall is a large chunk of text expertly describing how the Nazis dragged Europe into chaos and destruction. Then come a series of quotations from victims, including the one that seemed to tie the memorial together: "If you got off of the train with your little bag the Nazis knew you had something personal, something special inside. That bag was the last thing they took before they took your life." On the back side are the names of murdered relations of Oregonian Jews. This visit was especially poignant as we were there on Rosh Hashanah.

Last stop on our monument tour was “The Coming of the White Man,” by Hermon Atkins MacNeil (1904). Two Native men, one older, one younger, stand on a pedestal amongst the trees facing east, toward the Columbia River. It was the most difficult statue to find, as there was no signage, although a parking lot had been conveniently provided for anyone arriving by motor vehicle (we were on foot). We were not entirely sure what the point is: Chief Multnomah appears resolute, while the younger man is agitated (to violence? Is the object in his hand part of a torch or a dagger?) or maybe just surprised. The title does not name the figures we see, but rather the historical figures they saw: the white man/men not represented in metal. In this way the statue and its title appear to erase the Native American presence all over again, although they are standing right in front of us. Why did the designer decide to “honor” Native Peoples by depicting a Native reaction to Lewis and Clark, rather than as members of nations and cultures that existed independently of Europeans (and continue to exist)?

Did you miss the post about the Japanese Garden (I've added a new photo since it went live)? Have you ever seen a Chinese Garden?

Portland: Chinese Garden

Second day, second garden: Tuesday we visited the Lan Su Chinese Garden, whose name combines characters from the Mandarin for Portland and for its sister city, Suzhou. It means "Garden of the Awakening Orchids." We arrived early in order to be able to buy our tickets and join the free Kung Fu class that was held on the patio. (Every day they offer a different discipline to try; I suppose if you had a membership you could attend each week.) We spent a chilly hour learning how to move from our pelvises and how to roll a ball of qi with a woman visiting from California and another guy. The instructor, Andrea, is part of the Flying Tortoise studio.

Although we were very cold, the time we spent in the class had allowed the sun to rise over the building, improving the light. We followed the circuit of the compound, taking lots and lots of pictures. While Dear Husband favored the Japanese Garden for its spaciousness and greenery (click for post), I liked the Chinese Garden better, because of the constant juxtaposition of architecture and nature.

It is set up as a wealthy family's villa. One architectural technique they use is the “view within a view,” windows or doors that (re)frame dioramas. This not only simulates infinite space but allows for the artful display of conspicuous consumption.

According to the guidebook, there is more than 600 tons of the statuesque rock from Lake Tai in China in the garden (left image). The rock has been eroded under the surface of the lake, creating shapes that catch light and shadow and invite contemplation. Looking from bottom to top is supposed to simulate climbing a mountain.

There were of course a large koi and lily pond, bridges, a waterfall, and a couple of buildings with exhibits about a home altar (above), botanical illustration, women’s work, and the study of a Chinese scholar. We treated ourselves to a satisfying lunch (steamed dumplings for him, noodles with tofu for me, tea and moon cakes for each of us) while someone played a kind of lute. As a rare souvenir to hang when we get home, we bought a crane embroidery from Shouzou.

Below is the scholar's study. I took the second photo through an opening in a wooden screen, and the repeating window effect continues with the window and the decorated porch beyond it. How could you not love all that latticework?

Above left is the "moonlocking pavilion," so named because it seems to capture the moon (reflected in the pond) in its arms. Below you can see how close the rest of the city was.

This was a very filling lunch, I think because the moon cakes may be meant to be shared. You can see half of my red bean cake on top; it has a sort of dark, earthy taste. DH prefered his lotus seed cake, which was lighter and sweeter ("the vanilla of mooncakes").

This is a backlit photo of the two of us on a covered bridge overlooking the koi pond. Afterwards we walked over to Powell's City of Books, where DH patiently waited for me to scan the spine of every book published on Nazi Germany, and many of the books published on World War I. We also ogled the rare books--some of which are very old, some of which are oversized comics, and some of which are worth thousands of dollars--and did some Christmas shopping. Then we took the tram home for a quiet restaurant dinner and a soak in the jacuzzi tub.

Coming soon: posts about Washington Park and Multnomah Falls!