Nutrition Myths: Past & Present

I had the great honor and pleasure of delivering the June Internal Medicine Grand Rounds lecture. It has two parts. First, I introduce the history of medicine as a discipline and make an argument for why I did not waste eight years of my life pursuing a PhD in history. Then, I use short vignettes from the development of modern nutrition in Germany around World War I to explain three contemporary myths drawn from the longer list set forth in the “Nutrition Myths and Healthy DietaryAdvice in Clinical Practice.” One theme is the observation that one generation’s scientific fact is often the next generation’s scientific myth. For those of you who missed it, here is a slightly expanded version.







(Turn up your speakers to hear me better.)

Medical School Bloopers

I thought I would celebrate the end of my third year of medical school by sharing with you a Top Ten List of my most embarrassing moments from the first three years. I hope I don't collect as many from my last year--but between visiting rotations and traveling for interviews, I won't hold my breath. Without further ado, enjoy.

Top Ten List of Medical School Bloopers

10. When I squirted myself in the face with the hand sanitizer at the door in full view of the patient and his wife. Slapstick humor: 1. My dignity: 0.

9. The time I nearly fainted in an examining room. The physician was interviewing the mother and patient while I leaned against the sink because there were not enough chairs in the room. I don't know if I locked my knees or if my blood sugar was low, but I got hot flashes, started sweating, and my vision flickered. I tried to wait it out and shifted position a few times before I finally excused myself to find a chair, a snack, and a drink of water. When I returned no one said anything, and the doc didn't ask me about it later, which was a relief. This is why, like any good hobbit, I eat second breakfast!

8. The time on the Labor & Delivery ward overnight that I was so excited to be "scrubbing in" to a vaginal delivery that I dropped my sterile gown on the floor, then put it on before securing my face mask, which I did--but only after clumsily donning my sterile gloves. The tech called me out on it afterwards, and I readily admitted it'd been a hot mess. The patient ended up needing an episiotomy, so I didn't even get to catch the baby.

7. The time I catheterized a woman's uterus instead of her bladder. And then the time that I, a resident, and a nurse tried to catheterize a patient on the operating table who didn't even have a bladder anymore. Finally someone lifted up his gown and noticed the urine-collection bag on his abdomen.

6. That time I fell off a rolling stool in the OR. When we started the case, the floor was still wet from mopping, and I had joked that it would be a miracle if I didn't slip and land on my head. There's a maxim in surgery, "don't stand when you can sit, and don't sit when you can lie down." Since I was observing, I grabbed a rolling stool and positioned myself in full view of the operation. While trying to shift my weight, I accidentally pushed the stool too far forward. I slid off the back onto the floor on my butt, sending the stool skidding toward the sterile operating tables and gowned-up surgeon. Thankfully she was able to stop it before it contaminated anything, and I wasn't hurt, although the nurses joked that they were so busy I had to do my own neuro checks q15 (every fifteen minutes) to watch out for concussion.









"His heart is stopping! Nurse, give me the defr... defibi... uh... defrib...defibiri..."

"What, Doctor? What?"

"Oh, never mind."











5. The time I tried to treat myself for a urinary tract infection with left-over antibiotics from my medicine cabinet and nearly overdosed on a muscle relaxant instead. It was the week before I sat for Step 1 (my first board exam), and I felt sure I should just get out of medicine right then and there, obviously having learned nothing from an entire year of pharmacology.

4. Did I ask a 44-year-old patient who had had a tubal ligation at 18 and a hysterectomy at 30 what she used for birth control? And when she told me "condoms," did I proudly include that information in my report to the attending physician, who promptly did a double-take? Yes, yes I did.

3. The time I gave myself acute kidney injury. I knew I was volume depleted from finishing my period and giving blood, but I wanted to bike 10 miles to and from the farmers market the next day, so I went ahead and ate the verrrry salty dinner Dear Husband had prepared, thinking the salt would help me retain fluid and increase my blood pressure in the morning. Instead, I woke up with periorbital edema (puffiness) so bad that I could barely open one eye. I ended up drinking ridiculous amounts of water to flush out my system.

2. The time I "diagnosed" an image on a medical website as pornographic. Here's the original copy from facebook:

The medical students and residents are crowded into the attending's office to go through a computerized dermatology case that involves a photo of a tattoo. Attending: Now what do you suppose it's a tattoo of? It is an idle question that has nothing to do with the case, which we've just collectively solved. Someone points out that it looks like a person. Someone else volunteers that it looks like an insect eating a man. It suddenly dawns on me: the "insect" legs belong to a woman, who is crouching in front of a man. "It's a blow job!" I blurt out. Silence in the room. Most of these people have just met me yesterday.
Attending: "Oh my goodness, I think you're right!" Verdict: It was a tattoo of Olive Oyl going down on Popeye.

1. The time I tried and failed to find a posterior tibial pulse in a patient's left leg. It was a prosthetic leg.

What Medical School Looks Like XVII

You might be in the last week of your surgery rotation, if you find yourself eating the same Chinese take-out leftovers for dinner for the third time in four days.

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Surgery Rotation: Brought to You by the Letter "F"

Do you remember how on Sesame Street, each episode is "sponsored" by letters and numbers? Well, my surgery rotation has been brought to you by the letter F, as in "fantastic." It seems like everything that happens lately earns the same response:

Surgeon lets me use the scalpel and the electric cautery tool during a procedure? Fantastic!

Resident sends me to remove the staples from a patient's abdomen? Fantastic!

My patient with small bowel obstruction farted today? Fantastic! Wait--she pooped, too? Even better!

The gastric bypass patient has a leak in her esophagus? Fantastic.

The man who had colon surgery turns out to have rectal cancer? Fantastic.

My patient with cancer has bacteria in her blood and a hole in her intestine? Fantastic. She would not have survived an operation, so there was nothing for the surgery team to do but recommend antibiotics and wait. She died, twelve hours after going on hospice, three days after being admitted to the hospital, maybe six weeks after being diagnosed with cancer. She left behind a blended family with children ranging from middle school to the military.


Photo credit TT (6/13/2015).

As my community celebrates Relay For Life this weekend, we are spending a lot of time talking about cancer and remembering those whose lives have been impacted by this frustrating disease that continues to baffle modern medicine and to challenge us individually and together. I think of Susan, Julie, Keith, Linda, Essie, Tom, Jen, Rodney, Joanne, Glenna, Dale, Dan, Betty....

I've got another F-word: F*** you, cancer. F***, you.

What Medical School Looks Like XVI

Gardening while on surgery rotation. 

The spider plant is doing particularly well for having been abandoned in a cup of water on top of the china cabinet to root for several weeks. As for the rest...I will plant all three columbines outside and see if any of them grow next year. The dill and pansy plants are beyond hope of salvage.

Editor's note: Alas and alack, the parent and grandparent spider plants do not seem to have survived the fall semester of the fourth year of medical school.

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What Medical School Looks Like XV

When my senior resident dismissed me at 5 o'clock this evening (pleasant surprise!), I decided to take advantage of the lovely weather by unwinding at the park next to the hospital. After facebooking for a while, I lay back on the bench and completed my daily 10-question quiz while butterflies chased each other around me. Above is the view of the walking labyrinth, which is bordered by mint and butterfly bushes. A literal and spiritual breath of fresh air like this makes the surgery rotation bearable, despite having to get up at 4am, stand on my feet for hours, and rearrange meals.


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Children's Sermon: Pentecost as a Reversal of Babel

Unsurprisingly, one of the biggest challenges of writing children's sermons is figuring out how to translate Biblical texts for small children. After all, the Bible is a mishmash of genres (myth, poetry, political history, parable, hagiography) written for adults inhabiting historical and cultural contexts far removed from the 21st century. One favorite tactic is to use metaphors: "God is like..." or "The Kingdom is like..." Jesus employed metaphors all the time! But psychologists tell us that such abstract thinking doesn't develop until the teenage years. Another common tactic is simply to tell stories; the Older Testament and the Synoptic Gospels in particular lend themselves to this. However, what to do when a more complicated passage is the preaching text? How to teach our children better moral lessons for living? (Preferably ones bigger than "be nice" and "obey your parents," although I have fallen back on these at times.) I am also aware that the congregation is my audience as much as the kids who come to the front of the sanctuary.

Then there is the problem of props. I find that even five minutes of pure talk for a children's message is not riveting enough for most kids (especially the young ones who still come down the aisle for them). Having a prop of some kind at least catches their visual attention, and you hope that their mental attention follows! However, it is also entirely possible that they will become so engrossed in the prop that they do not hear what you're saying.

With these monthly conundrums in mind, I tackled the Scripture for Pentecost (Acts 2). Seeing it with fresh eyes and ears this year, I was struck by the list of "God-fearing Jews from every nation under heaven" who had gathered in Jerusalem for Shavu'ot (the Feast of Weeks, to celebrate both the first fruits and the giving of the Torah). Somewhere or other I had read that Pentecost can be seen as a reversal of the Tower of Babel myth in Genesis. Building a tower with blocks would give us something to do while talking about God's relationship to all nations, so I decided to run with it. Here, more or less, is the children's message I delivered this Pentecost Sunday.

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Good morning! I'm so glad you came up front this morning, because I need your help with these blocks. Can you help me build a tower? Let's see how high we can make it!

Do you know the story of the Tower of Babel? It's a myth in the Older Testament of the Bible. Long, long ago, in a land far, far away, the people wanted to be closer to God. This was back when everyone spoke the same language. So they got together and decided to build a tower allll the way up to heaven. However, God knew this wouldn't work, so the Bible tells us that God "confused" their languages. They couldn't talk to each other anymore, so they had to give up on the tower.

However, the people and God still wanted to have a relationship with each other. So the Newer Testament of the Bible tells us that God sent Jesus. He lived, and taught, was crucified, died, and buried, and then he rose from the dead. After he was gone, the Holy Spirit came to inspire the disciples to share the Good News to people from all the different countries in the world. Even though they all still spoke different languages, now they could understand that God loves them and that they should work together to build the Kingdom of God on earth.

Thank you for your help today. You know the point wasn't to build a tower out of blocks, right? It was to build the Kingdom of God for everyone. Let's pray about it: Dear God, thank you for the Holy Spirit. Help us to build your Kingdom. In Jesus' name, AMEN.


We left the tower standing in the chancel for the rest of the service as a reminder to the congregation of Pentecost as a reversal of Babel.


Editor's Note: some of my other children's sermons are on the Transfiguration and Holy Week.