National (Almost) Doctors Day

To our Doctors: Thank You.
Posted by Nemours on Wednesday, March 30, 2016

Today is National Doctors' Day, a chance for hospitals, support staff, and patients to thank their doctors. The newborn nursing staff at one of our local hospitals bought the docs a basket of snacks and goodies they shared with the medical students after noon conference. Hillary Savoie over at The Cute Syndrome wrote a heartfelt thank you to the many doctors she has encountered during her daughter's life with special needs.

Hillary also posted the video above, from the Nemours Children's Health System. (I interviewed at Nemours/Alfred DuPont Children's Hospital in Wilmington, Delaware.) The text lauds the day that "you" decided to become a doctor. It occurred to me that I cannot remember the day I made up my mind about this career choice. I have wanted to be a doctor since before I can remember. When I was a preschooler, my father played "order-lady" (orderly) for my stuffed-animal patients lying in hospital beds made of wooden blocks while I ministered to them with my PlaySkool doctor's kit. I don't know why I wanted to be a doctor then.

I made the decision again in elementary school--now to be a pediatric neurosurgeon like Dr. Benjamin Carson--because it sounded hard, and I liked the admiration the declaration won me from elderly neighbors and substitute grandparents at church. Apparently my pediatrician told me to choose anything but medicine, but I wouldn't listen to him.

In middle school, I once wrote that I wanted to practice medicine as my first career, serve as President of the United States as a second career, and then retire as a United Methodist minister in some local church. (I kid you not; Dear Husband can corroborate this.) It was all "service," and you can't even run for POTUS until you're 34-going-on-35, so it all made sense to me.

In high school I decided to become a doctor in order to help people. Young radical, I bristled at injustice and wanted to right the world's wrongs. I toyed with the idea of medical missions abroad, or practicing addiction medicine among the inner-city homeless here in the United States. Then I met my now-husband, whose own career was incompatible with a dusty village or a refugee camp, so I dreamed again.

In college I had my first crisis of confidence. Although I knew I wanted to work with kids, I didn't want to be a general pediatrician ("too boring"!), but a dear family friend and nurse warned that I wouldn't like myself after neurosurgery residency and that there were plenty of other kinds of doctors. At the same time, I learned about PhD "not that kind of doctor" doctors and changed my plans from medical school to a dual-degree program (MD/PhD). I remember lying on my parents' bed one night, confessing to my mother that although I liked anatomy and physiology, I worried that I wasn't actually going to like the day-to-day practice of medicine, and the prospect of reading books all day as "a historian" sounded much more appealing. She promised to support me in whatever I chose, so I decided to become a doctor-doctor.

Over the last twelve years, whenever I have switched between graduate and medical school, I have fallen in love with the idea, and the reality, of these fields all over again. When the stress of exams made me consider giving up, I had to choose to recommit myself. The healthcare system is just as broken as when my pediatrician advised me to find career happiness elsewhere, but the ability to sit in an ICU workroom and talk about pathophysiology, the history of medicine, or the social contexts of end-of-life care is a dream come true. I will probably never make a living teaching or writing history of medicine, but it has shaped the physician I will become in just over one month.

The next year of medical training promises to be one of the hardest in my life physically, mentally, and emotionally. Every time I roll out of bed before the sun in order to hit the wards for pre-rounding, I will decide to be a doctor. When I find myself explaining what antibiotic resistance is and why I won't give an unhappy patient an antibiotic for an infection that is most probably viral, I will choose to be a responsible clinician. And when I comfort a patient or a family, I will recommit myself to becoming the kind of physician who earns a little extra "thanks" on Doctors' Day.

Creamy Seafood Casserole

Shrimp & Dill Pot Pie (adapted from McCormick & Co.*)

Pre-heat oven to 400F. Saute 3/4 cups chopped red onion (1/2 of a large one) in some butter. Add 1.5 pounds peeled and deveined shrimp and cook until just pink. Meanwhile, whisk 1.5 cups half and half, 1/4 cup dry white wine, 1/4 cup flour, 1 tsp dill, 1/4 tsp thyme, 1/4 tsp salt. Blend well and add to skillet. Bring to a boil gently, stirring constantly. Simmer at least 2 minutes, or until sauce thickens. Pour into a 3-quart dish with 1.5 cups sugar snap peas and 1/2 cup frozen peas. Open a 12-oz package of flaky biscuits and separate them into halves, then layer over the mixture. Bake 10-15 minutes or until topping is golden brown. Ladle into bowls; serves six. Goes well with tossed salad or broccoli salad.

*Reminds me of home in Baltimore, where their headquarters is.

Easter 2016: And all the people said, "Amen, let's eat!"

Easter 2016 combined many traditions from the last few years: I "danced" in the light of Christ wearing my custom-made rainbow stole to start two of the services at church; Dear Husband and I ate Easter breakfast in the church kitchen of dyed eggs, milk, and fresh cinnamon rolls; and there was potluck--two this year! One each for lunch and dinner. Wanting to be sensitive to people's various dietary needs, I decided to bring a vegan and gluten-free broccoli salad adapted from my MIL's recipe. You can of course use regular mayo and even add crumbled bacon if you like.

Vegan and Gluten-Free Broccoli Salad

2 heads broccoli, 1/2 red onion, a bunch of red grapes, 1/2 cup raisins--all chopped and mixed. Dressing is 1 cup vegan mayo, 2 tablespoons white vinegar, 1/2 tablespoon prepared mustard (I used "spicy brown mustard"), and a little sugar or sweetener to taste (I used Truvia). Mix, chill 2 hours, enjoy! Recommended: John Oliver's Last Week Tonight on YouTube during all the prep.

At our second potluck, M. introduced us all to Resurrection Rolls. This is a great Youth Group snack/teaching point. Here's the recipe, complete with irreverent interpretation.

Ingredients: 1 package of crescent rolls, torn into chunks; 8 regular-sized marshmallows; 1/4 cup melted butter; white sugar; cinnamon.

Directions: The marshmallow is Jesus. Anoint his body with burial spices (the melted butter, sugar, and cinnamon standing in for myrrh and frankincense). Flatten out a chunk of dough and entomb him completely, taking care to seal any cracks. Consign Jesus to Hell at 375F for 10 minutes (or follow package directions). Et voila! When they come out of the oven, each roll should form a hollow--empty--tomb. Best Love Feast ever.

We ended the night with three rounds of a cooperative "board" game called Forbidden Island. The scenario is a group of treasure hunters contributing unique skills to acquire four objects before the island sinks. I loved the team-work of maximizing turns and negotiating steps to out-pace the rising tide.

Look at all these happy Easter people! P. is wearing the lei because it was her first-ever Easter egg hunt. It's the same set of plastic eggs with inspirational quotations and corny jokes, now filled with some of my surfeit of chocolate.

What Medical School Looks Like XXX

This is all the swag that I collected on the residency interview trail: four mugs, two flash drives, a drawstring backpack, a carabiner with measuring tape,  a cell phone caddy, chapstick, hand sanitizer, chocolates, pens, a stack of business cards, and a leather business folder (from a Harvard program, natch). Probably the most unique gift set came from the Internal Medicine/Pediatrics program at University of Pittsburgh Medical Center (UMPC): a mini bottle of Heinz ketchup, a tiny Heinz pickle pin, and Mr. Yuck stickers. Heinz is of course a Steel City original, and the poison control logo was designed at Children's Hospital of Pittsburgh, where I will do half of my residency training. I promise the goody bag didn't have any impact on my rank-order list, but now that I have matched, I can start sporting UPMC pride!

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I Matched!

After months of applications, interviews, and waiting, I am pleased to announce that I have matched in Internal Medicine/Pediatrics at University of Pittsburgh Medical Center (UPMC). This is a combined residency program that smashes six years of training in adult and child medicine into four years. Med/Peds is still the shortest program I could find to let me get out into practice to do what I love after twelve years of graduate and medical school. Doctors who complete this pathway can either become specialists or work in primary care. I intend to do both by entering a niche called "complex care" that includes both diagnosing and treating rare diseases in the hospital and taking care of individuals with multiple life-long health-care needs in the clinic. I imagine my target population as kids with developmental disabilities and related conditions (such as cerebral palsy or Autism Spectrum Disorder)--and their families. Once they age out of their pediatrician, they can still see me, since I will be double boarded in Internal Medicine and Pediatrics.

If you are following along on my Medical Grand Tour, UPMC was one of the last places I interviewed. By January I finally had an idea of what kind of career I want, and what kind of training I need to get there. Med/Peds at UPMC offers all that in an academic medical center--and the #8-ranked children's hospital in the nation--and infrastructure already in place to support the medical humanities--in a mid-sized Midwestern city on the water (three rivers, to be exact). An up-and-coming place, Pittsburgh is five hours from Dear Husband's family and four hours from mine, so the location couldn't be better. Really, it was a no-brainer. So for the last two months, I've been waiting to confirm what I already suspected: that I had found my match, and I didn't even have to kiss a frog. (The mosaic below is from the Pittsburgh Children's Hospital.)

The official photographer didn't get any photos of me making the announcement (how rude!), but you can watch me do so on YouTube by clicking here.

If you're curious how this whole Match thing works, Dear Husband wrote a blog post you can find on the Pianonoise blog.

Click here to see where my classmates matched!

On Being a Guinea Pig

I recently agreed to take part in a pilot study on campus that is looking at the cognitive and physical health of middle-aged women with multiple sclerosis; I volunteered to be a control. There were three parts to this experiment: first, I did exercise tests, including a max-fit test. It was quite the set-up: I'm on a seated elliptical machine (a NuStep), with a clip on my nose, wearing a headpiece holding a flexible tube coming out of my mouth to measure gases and respiration. The resistance got harder every minute, and around 15 minutes I was sure each level would be my last. I conked out at 18 minutes.

The next time I came back for cognitive and memory testing. I quickly figured out that if I could categorize the nine words the tester asked, it was easier to remember them. We also did two sorting tasks (my favorite: patterns!), and a couple of activities on the computer whose point I couldn't quite get. One was to memorize the relative locations of little squiggles on the screen (the "dinosaur" went next to the "angel," which was above the "saxophone"--or did that one look like a "squirrel"?); the other involved remembering which alien creatures went with which landscape photographs. That one had an ignominious end, when a piece of bad code ended the session early.

Finally, I went in for a brain MRI, my first ever. I know they are supposed to be claustrophobic and loud, but I wasn't prepared for the reality. I was all snuggled in under a fresh warm blanket (blanket warmers are the best!), with a pulse oximeter on my finger and a panic button in my hand. There was also a strap around my chest to measure respirations and earphones wedged between my ears and the headpiece. The "helmet" was the worst. It looked rather like a football mask and blocked my vision--that was worse than being in the tube. There was also a mirror, but all I could see was a blank television screen. I had to lie still for at least 45 minutes while they ran different tests. I had hoped to catch some ZZZs since I'd been up late writing, but hold on--that little knocking became banging and other alarming sound effects. I bet everyone is tachycardic during an MRI; even metoprolol couldn't give you enough bradycardia to overcome the noises in that thing. I swear, you could not design a machine to sound more like the patient is being shot at with space lasers than this MRI machine. Speaking of being shot, I seriously think the waiver or consent form should have asked about Post-Traumatic Stress Disorder (PTSD) in addition to shrapnel and other foreign metal bodies. I could easily see the experience being triggering for someone who had residual experiences from a war zone. Personally, my least favorite scenario involved 12 minutes of having the air pillow under my head rapidly inflated and deflate at various frequencies. I felt like I would vibrate for days after that one ended. I didn't. A little ibuprofen for my poor knees, and then hoping they get enough participants to learn something useful. Just doing my academic duty for the amazing women in my life who actually live with multiple sclerosis every day.

Children's Sermon: the Jesus Fish

This morning's children's sermon was an illustration of the importance of being flexible while trying to stay on message. The following is a transcript of what (should have) happened.

~ * ~ * ~ * ~

Good morning! How are you today? I'm so glad to see you. Today, I have a riddle for you. Are you ready? What...is the sound of one hand clapping? [I get some garbled answers, finally someone says, "silence!"] Listen! [I flap the hand that isn't holding the microphone.] One hand can't clap by itself! But two hands can clap together, because "Two are better than one." (Ecclesiastes 4:9a) [I get two of the girls to hive-five/clap my hand.]

Okay, I have another riddle. I'm going to draw you a picture. [I draw one, long, curved line on a piece of paper.] What is it? ["A hill!" "A smile/frown!"] Hmmm, maybe it's not done. Pastor Sheryl, could you complete the picture for me, please? [This is where the train derails, as she has a brain freeze and can't remember that I had asked her at the start of the service to help me draw a "Jesus fish." So she draws two eyes and a nose. "A face!" says one child. "Teamwork!" declares another. Teamwork it will be, as half a dozen children take turns adding teeth, a tongue, and a head to the face. I compliment them on their cooperation but attempt to steer the conversation back on track.]

Well, that's one way of completing the picture, but this is what I had in mind. [I scrawl two intersecting curved lines on the other side of the paper.] What does it look like? ["A fish!"] Yes, a fish, the "Jesus fish."

Have you ever seen a fish like this before? Maybe on the back of someone's car? Why do you suppose the fish is a symbol for Christians? ["Fishers of people," the feeding of the 5000/fishes and loaves, big catch of fish on the other side of the boat.]

A long time ago, when Christians were trying to find each other but couldn't say it out loud because they were being persecuted, one of them might draw a line like this--maybe in the dirt--and if the other one finished the drawing of the fish, then they knew they had found another Christian.

In one of my favorite verses in the Bible, Jesus says, "For where two or three gather in my name, there am I with them." (Matthew 18:20) Let me say that again, "For where two or three gather in my name, there am I with them." That means that whenever we get together for Christian fellowship, Jesus is with us, through the power of the Holy Spirit.

How can you be in Christian fellowship this week? [Say grace before dinner, pray together, donate to the poor, go to Wednesday Night Live, attend Sunday School and church.] Those are all great ways to be together in Christian fellowship with the Holy Spirit.

Will you pray with me? Awesome God, / Help us / to love each other, / in Jesus' name. / Amen!

~ * ~ * ~ * ~

Sheryl and I laughed about it later. No harm done, and I'm hardly going to complain about a "mistake" that gets the children more involved in the lesson. In case you were wondering, the "Jesus fish" is a play on a Greek acrostic: Iesous Christos Theou Yios Soter (Jesus Christ, God's Son, Savior) = ichthys = fish.

N.B. ~ Other children's messages have been about mountaintop experiences and United Methodists around the world.

Lunch Munchies

I don't know about you, but I am a creature of habit, especially when it comes to food. Breakfast is yogurt and muesli, or oatmeal, +/- an egg, except always two pancakes with peanut butter and maple syrup on Sundays. Lunch during the week is a sandwich, carrots or celery, and chips. I eat an apple and "a little something" (cookies, chocolate, nuts) for afternoon snacks. Dinner is whatever Dear Husband or I make, but it must include a starch, a protein, and a vegetable.

Lunch on weekends is different, because I don't have to pack it into tupperware or ziplock baggies to take with me. So I like to enjoy something different, like salsa with tortilla chips. Or soup and crackers. Today, I decided I was in the mood for "munchies" for lunch--little bits of different things I like to eat. After I put it together, I realized there is a common theme among the items. Can you figure out which is the odd one out?

Making it Official!

American-flag fruit pizza

St. Patrick's Day is celebrated by college-types around the country with bar hopping. It's also almost Spring Break, when the undergrads (and some of the grads) get out of town for home, or the beach. Some years St. Patrick's Day falls during Spring Break, to the disappointment of the owners of the bars in our town. So a couple years ago they decided to create a new holiday, the sole purpose of which is to make racist jokes about Native Americans and to get sloppy drunk, preferably paying said bar owners for the privilege of drinking beer and throwing it up again on the sidewalk. This "unofficial" St. Patrick's Day has become an annual headache for instructors, the university administration, the local police, and departments who occasionally make the mistake of scheduling recruiting events for the same Friday/weekend when it seems like the entire population of 18-25-year-olds for a 2- or 3-hour radius dons green clothes and descends on Campus Town to drink. It's actually not entirely a laughing matter, as some years there have been deaths from traffic accidents.

Anyway, you needed that backstory to understand the party we held this year on "Unofficial." Some of our closest friends are in our Bible study, a motley crew of graduate students and like-minded folks who get together on Tuesday nights to talk about faith and other times to hang out and enjoy each other. One of them recently got her green card approved after a looong process, so to celebrate, we held an "Official" party for her. It involved wearing green, mint-chocolate-chip cookies, margaritas, and apple pie, because America. Of course we played Apples to Apples--green card, anyone?

For an entree we had chaat, an Indian street food. There are a variety of recipes, but this one involves chips, potato, chickpeas, yogurt, onion, tomato, tamarind chutney, and masala powder. Here's my bowl before I stirred it up into deliciousness. Cheers to being one step closer to citizenship!

p.s.--It's a total in-joke, but for posterity's sake I thought I would record the group decision on which nine states would be included in our perfect republic. You see, the flag on the fruit pizza above only has nine stars, so we debated the merits and finally decided to keep California, Colorado, Hawai'i, Maryland, Massachusetts, New York, Tennessee, Texas, and Wisconsin. Sorry, Ohio. Maybe you can become South Canada.