Sunday, December 29, 2019

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!

Friday, December 20, 2019

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." 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.


Thursday, December 12, 2019

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.

Thursday, December 5, 2019

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.
Cookie Monster Clip Art -
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."