Saturday, February 29, 2020

That So Pittsburgh: Underground Railroad Tour

Today friend J.H. invited me to join her on a Doors Open bus/walking tour of sites connected to Pittsburgh African-American history. We gathered in Market Square before boarding four yellow school buses and spreading out around the city. Bus #1 started at Bigham House on Mount Washington.

Thomas James Bigham (1810-1884) built this brick mansion in 1849 above a ravine on land his wife Maria brought to their marriage. Known as "the Sage of Mt. Washington," he was a successful trial lawyer, local and state politician, newspaper publisher, and abolitionist. Their home was reportedly a stop on the Underground Railroad. After listening to a docent tell us about the history of the people and the place, we were allowed to have a look around. There wasn't much to see, as the house is currently a private community center without the historical furnishings or decorations.

Next stop was Morning Glory Inn on the South Side. A chic bed and breakfast that caters to weddings on the weekends and business travelers during the week, it was included for the unusual brick-lined vault off the basement that *might* have been constructed at the start of the Civil War in order to be used for the Underground Railroad and most definitely saw use during Prohibition.

Next we returned to Market Square to visit The Original Oyster House, Pittsburgh's oldest bar and restaurant. It was opened in 1870 to sell oysters and beer. The next owner (1916-1970), Mr. Americus, had a second house in Atlantic City and used to attend the Miss America pageants, so the walls are covered with old photographs of the contestants. The various fashions and physiques are fascinating. The next owner (1970-2019?), Louis Grippo, had a law office above the bar, as he was a successful defense attorney. "He never lost a murder case in his whole career!" according to his widow, who gave us the spiel instead of their daughter, who currently runs the joint but was in Seattle representing the city at a young entrepreneurs event. Mr. Grippo sounds like quite the local character, and he's the one who covered the rest of the walls in photos of famous people. I don't know why we stopped here, but I did learn that the only oysters they still sell come from a particular spot in the Chesapeake Bay, as they couldn't afford the insurance coverage for the shuckers if they served oysters threatened by toxic algae blooms.

Last stop was the original Dollar Bank building, which I have already featured on this blog for its famous lions and imposing facade. This Pittsburgh original--founded on my birthdate in 1855--has been accepting deposits from all manner of Pittsburghers for 165 years and sponsored this tour. They even have a half-time employee and a history graduate student from Duquesne interning to do research into the African-Americans and immigrants who signed their deposit books. There are multiple rooms on the main floor of the bank building devoted to its history and rotating exhibits such as this one. Among other things, the two historians showed facsimiles of 1860 Census forms on which two enslaved men were recorded by just their age, sex, skin color, and owner. But because they had shared that information when they later signed up at the bank, the researchers could put names and stories with these otherwise dehumanizing records. This was an uplifting way to end Black History Month.

Editor's Note: You might also like this post about a group of creatives and artists, or else this three-dimensional bit of clever public art in the Pittsburgh Airport

Friday, February 21, 2020

Identity Badge

I finally found the attractive yet useful way to display my Ravenclaw pride: a badge clip handmade by Etsy user The Crafty Opera Singer "with LOVE and MUSIC." Patients who don't know Harry Potter will likely ignore it, while those who recognize the raven will get a kick out of it.

Or yet in wise old Ravenclaw,
If you've a ready mind,
Where those of wit and learning
Will always find their kind.

Saturday, February 15, 2020

What Residency Looks Like LXXXVIII: The Final Countdown

Sometimes residency sounds like listening to 1980s synthesizer pop songs while studying neurology over breakfast in the hospital cafeteria before a moonlighting shift in the Neonatal ICU. It was a bold choice for 6:30 on a Saturday morning, and I salute whomever decided we needed Bonnie Tyler and Duran Duran to jump-start our day.

Incidentally, there are just 136 days left in my residency program (but who's counting?). I'm hoping to get to an even 100 What Residency Looks Like posts by then. For your nostalgic enjoyment, here's the official music video for Europe's famous song:


Monday, February 10, 2020

What Residency Looks Like LXXXVII: Doppelgaengerin

Sometimes residency looks like your facecard hanging on the wall when you are the "Clinic Supe" (supervisor) for the month. It's a relatively new position whose duties we're still figuring out, but so far it involves leading the pre-clinic conference lesson, managing the flow of patients, teaching the medical students, handling paperwork for absent residents, answering all manner questions, and blogging about it. I am also doing a small quality improvement project about making referrals for nutrition counseling.


Sunday, February 2, 2020

What Residency Looks Like LXXXVI: On Red Team, we are positive

Over the course of one month, Red Team took care of 102 patients: 64 women and 38 men. They ranged in age from 20 to 95 years old, with an average of 63 years old. While most were admitted for 2-3 days, their length of stay ranged from less than 1 day to 52 days, with a few long admissions pulling the average up to 6 days. There were three codes and two deaths. One patient signed himself out against medical advice. We transferred 2 patients to Family Medicine, 2 to Cardiology, and 1 to Cardiothoracic Surgery.

We learned about such rare diagnoses as Sturge-Weber Syndrome, Castleman Disease, and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). We also took care of patients with common medical conditions: atrial fibrillation, congestive heart failure, pulmonary embolism, and infected foot ulcers, and we practiced managing pain, blood pressure, and blood glucoses in the hospital.

One patient refused dialysis, but his kidney function improved anyway; another patient's kidneys got worse and had to be started on dialysis. Most of the people admitted with chest pain concerning for heart disease were discharged with other diagnosis, but two of them went to the cath lab to get stents for on-going myocardial infarctions, and in the process they reminded us that women's heart attacks can present differently than men. We diagnosed four people with cancer, one of them for the third time.

The team shared lighter moments, such as the patient who asked us to autograph her facecard.* The workroom was often filled with laughter, sometimes with music, and once we smuggled a chocolate candy bar on rounds. Some patients had interesting allergies listed in their electronic medical records: tomatoes (reaction: worsens arthritis^), oral diuretics (but somehow not IV diuretics), and cocaine (!). One woman took a record number of herbal supplements at home (9).

There were difficult moments: The patient who made sexist comments about one of the medical students in the middle of morning rounds. The woman who didn't like the intern who wears a headscarf and speaks with an accent. The patient who insisted against all evidence that the interns had asked the nurses to dilute her pain medication. The family member who complimented "the colored boy," a young African-American patient care technician who helped feed her husband when he couldn't do it himself.

There were moving moments: One man had a peaceful death in the same wing of the hospital in which he had been born. One of our "difficult patients" thanked me for pulling up a chair most afternoons of her month-long hospital stay: "No one else comes to visit me." Another "difficult patient" cried when I told her that I was rotating to a different hospital. We became close with the staff on the floor, too, including one of the nurses, who--having been publicly berated by a patient's family member--tearfully confessed to me, "I feel like I'm a member of your team."

Medicine is a team sport: patients, doctors, families, nurses, consultants, food service, environmental service, operators, therapists, care managers, social workers, secretaries, and ED staff. We don't always agree on the diagnosis or the plan, and sometimes no matter how hard we try, we cannot not fix a patient's problem, but the important part is that we are in it together against pathology and red tape, not each other. This weird and wonderful calling of caring for sick people, often at their worst moments, can sometimes bring out the best in us and others. On Red Team, we are positive.


*A facecard is just what it sounds like: a piece of card stock with the names and faces of the medical team taking care of the patient.
^This medical myth was promulgated by a 1993 theoretical paper but has never been substantiated by high-quality evidence.