Someday gets closer

Today was a relaxing day. I was happy with how my defense went yesterday, and even happier that it was over and finished. Here I am with the poster announcing my defense:
I don't officially get my degree until I finish the MD in 2013, but I like to think I have an unofficial doctorate. In any case, I had a fantastic time celebrating afterward with friends and family yesterday, and am particularly pleased to note that there are more celebrations already in the works. Carrying the celebrations into today, Ruti sent me beautiful flowers:

The box also contained chocolates, so she wins double (maybe even triple or quaduple) points.

Alicia and I also went to the opening gala of the Ann Arbor Film Festival, which was notable both for the films (which were great), and the people watching (which was amazing). I really enjoy events where the old hippies and the young hipsters mix and mingle.

There was also tasty food, including cupcakes, which made my day complete.

Tomorrow, I go and officially buy my car! (It is reserved for me and all the paperwork is done, but I have to actually buy it tomorrow…) Watch for the classic car ad photos of me in some kind of skimpy dress modeling on my car in the ice pellets we’re supposed to get tomorrow. Or not…

Delicious

Having finished most of the big things required for my PhD, I’ve made a little resolution to make sure I’m cooking more. It’s not that I was eating particularly unhealthfully in the traditional sense, but I would consider eating cereal for more than one meal per day more than 3-4 days per week to be unhealthy, even if there are lots of fruits and vegetables on the side. It is monotonous, and makes me feel a little desperate and somehow… mentally unhealthy. The best course of action when I’m feeling this way is to peruse some cookbooks. My go-to options are Mark Bittman’s How to Cook Everything and How to Cook Everything Vegetarian. Between those two, there is a recipe for just about everything a person could wish to eat, all of them are fairly easy, and many are flexible based on what is in my refrigerator/freezer. Every time I think I’ve found all of my favorite recipes, I find another. Today, I present to you a delicious way to use chick peas and all kinds of random vegetables. This is a serious refrigerator cleaner!

Stewed Chickpeas and Crazy Delicious Trimmings

adapted from How to Cook Everything by Mark Bittman

4 cups drained cooked or canned chickpeas
2 cups bean cooking liquid or stock (or some combination)
salt and pepper to taste
1 tablespoon grapeseed oil
1 zucchini, chopped (this is optional, or you could use eggplant or some other hearty vegetable you aren't sure what else to do with - I foresee this being very popular when the zucchini plants being producing more than your typical human can cope with)
1 package of chorizo flavored seitan, or some other delicious meat or non-meat protein (the original recipe uses chicken)
1 large onion, chopped
3 celery sticks, chopped
2 carrots, chopped
1 tablespoon minced garlic
1 teaspoon peeled and minced fresh ginger
1/2 teaspoon ground coriander
1 teaspoon ground cumin
1 28 oz. can tomatoes (drain more or less depending on how soupy your like your stew)
minced cilantro for garnish

Warm the beans in a large pot with the liquid; add salt and pepper. Adjust the heat so that the mixture bubbles very slowly.

Place the oil in a large skillet and turn the heat to medium-high. Brown the zucchini and fake chorizo, about 15 minutes. Transfer to a serving bowl, leaving any remaining oil in the pan.

Turn the heat to medium and add the onion, celery, and carrot, as well as a bit more oil if necessary. Cook, stirring occasionally, until the vegetables are the consistency you like your stew – mine were slightly crunchy. Add the garlic, ginger, coriander, cumin, and tomatoes and cook for 5 minutes more. Stir occasionally and scrape the bottom of the pan to loosen any brown bits. Add the mixture to the simmering beans and let simmer for a bit (5 minutes?), or longer if you like a less soupy stew.

To serve, ladle the stewed chick peas into a bowl, spoon over the zucchini and fake chorizo, and then garnish with chopped cilantro. So delicious!

Brain recovery…

Apparently my last post sounded despondent enough to concern my mother, so here I present to you the post of reassurance. In addition to freaking out a bit about returning to the hospital, I have been doing the following to recover from the stress of defense preparation:

1. Taking gratuitous pictures of the dog. Enough said…

2. Reading books that could in no way be construed as upsetting or stressful. I just finished reading Knit The Season by Kate Jacobs, the third book in the Friday Night Knitting Club series. It was great. The writing was perfectly acceptable, the plot was entertaining, and enjoying it took approximately no effort on my part.

3. Making new brains!

We have a long tradition of making chocolates for big events (graduations, weddings, green card approvals, etc) in our family, and even though I’m not actually getting the PhD for another few years, mom suggested that we make chocolates for my defense (with the promise of more chocolates when I actually graduate). After perusing Amazon’s dazzling array of chocolate molds, I found the brains. They proved to be somewhat larger than expected (the story of my family, I suppose…), but look pretty awesome.

Starting to seem real

My defense is happening in a week in a half (in case you’ve been wondering why my posts have been, how shall we say, irregular recently), and it’s finally starting to seem like I’m going back to medical school.

I went and saw the Smoker last weekend, which is the University of Michigan Medical School’s student-conceived, –written, –directed, –acted, –danced, and –sung musical about the medical school and the hospital. It is always based on a movie or musical, and this year was a medical version of Mean Girls: Spleen Girls. Seeing it made me miss participating - I danced and had small non-speaking walk on roles in Orifice Space (Office Space), The Breakfast Clubbing, Cyanosis, and Edema (The Breakfast Club), Billy Medicine (Billy Madison), and Old Stool (Old School) – and also reminded me of how much UMMS trivia I have yet to learn as an M3!

I’ve also been thinking about some of the practical parts of going back to the medical school. I’m ordering a few extra white coats (so that I have some laundry leeway), thinking about my car situation (after my trusty ‘93 Escort died in December), and looking into dog sitters/walkers for Walt. It’s all a little overwhelming, so I’ve been reading, knitting, and sleeping to avoid addressing everything for a little bit… As it gets more real, however, it’s becoming unavoidable.

Meet Dr. Watson

From Dose of Reality:

Shortly after I heard about Watson the super computer’s debut on Jeopardy, I was talking on the bus with Abe and he asked what I thought about Watson’s next big challenge: medical diagnosis. I appreciated Abe’s assessment that I wouldn’t be upset at a question that cut directly to the issue of whether a human being is necessary in a typical medical visit, and had to admit that it was a disconcerting prospect. Adequate as I like to imagine my information processing capabilities are, I am not, at the risk of stating the obvious, a super computer. My constant connection to my BlackBerry doesn’t allow me the same level of internet search that Watson commands, and familiarity with statistical software and electronic medical records do not an instant meta-analyzer make. In spite of the nagging fears at the back of my mind that Watson would make a much more useful companion on rounds than I would, I couldn’t shake the sense that it had to be useful to have a human physician (or for that matter, a human nurse, physicians assistant, etc) for something. At that point I remembered a recent New York Times article by Abraham Verghese. Recently profiled in the NYTimes for his dedication to history taking skills and the physical exam, I knew that if anyone could justify a human presence in the consult room, he could. And he did. He pointed out that much of the value of a doctor’s visit is in the human interaction, noting:

I find that patients from almost any culture have deep expectations of a ritual when a doctor sees them, and they are quick to perceive when he or she gives those procedures short shrift by, say, placing the stethoscope on top of the gown instead of the skin, doing a cursory prod of the belly and wrapping up in 30 seconds.

He chastised the medical establishment for being “glued to [computer] like piglets at a sow’s teats.” He describes the creation of an “iPatient,” the collection of clinical records and test results that stand in for the patient, and emphasizes that “complaints…from patients, family and friends are never about the dearth of technology but about its excesses.”

We have yet to create appendages for Watson that function as well as the physician’s hands, ears, and eyes for assessing the physical state of the body, and it seems unlikely that he will develop the ability to empathize and connect with a human being anytime soon. Ultimately, it seems that although Watson may, in fact, make an excellent companion on the wards, he is unlikely to truly replace a skillful (human) history and physical exam.

It really does start to come back

From AMSA On Call:

Post #6 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

It’s hard to believe I’m already at post #6 in this series. I’ve been averaging about one each month, which means that almost half a year has gone by. In that time I’ve done a lot of things to prepare me for my return to the medical school! I’ve scheduled a dissertation defense, written a dissertation (only edits and formatting left…), and worked with two different internal medicine attendings to try to remember how to be a medical student. Believe it or not, I think that the last item on that list has been the most anxiety provoking. Something I can tell you for sure, however, is that it really does come back. Something else I can tell you is that apparently anything can feel normal after you try it a few times. If you had told me just a few weeks ago that I would casually walk up to one of the nursing stations in University Hospital, have someone help me identify a patient, and then take a reasonably competent history and perform a slow and imperfect, but adequate physical exam, I would have laughed at you. If you had said that I would attempt to present this information to an attending I would have cried. So take heart, whether you are simply making the transition from the pre-clinical years to working on the wards, or you are working to regain the skills you had before a break, because it all really does come back.

Things that distract me…

I have a few things I’ve been saving up to blog about, but none of them are very long, so it made the most sense to combine them into one larger post. When I sat down to consider how to unite them, it was almost too obvious: things that distract me. There’s even an additional meta element here, because writing the blog also distracts me…

1. Walter: This should be obvious to anyone who has spent more than 15 seconds looking at the blog. I got a new tiny, tiny video camera from the Point Foundation and, of course, tested it out with Waltini.

2. Crafting: Though last week wasn’t exactly the Valentine’s Day I’d always dreamed of, I had a really good time crafting cards for friends. Design*Sponge (also high on the list of distracting things – this one is thus a two-for-one) had previously posted some really, really cute fruit sticker templates (stay with me here folks), and so I dutifully printed them out, obtained a punch, and stuck them to some delicious-looking oranges to share around. I gave all of the oranges away (they said “Orange You Glad You’re My Valentine”), but here is a shot of the apple sticker:

I would encourage you to print some of these yourselves and put them on fruit in your own lunches, or those of people you care about, because they are funny and cute, and only the orange one is really specific to Valentine’s Day.

3. Reading: Motivated not only by the large number of good book available, but also by the calming effects of reading something unrelated to my dissertation before I go to bed, I’ve been slowly working my way through a variety of fiction and non-fiction books this past year. The most recent was Killing Pablo: The Hunt for the World’s Greatest Outlaw, which Ruti recommended after Alicia and I decided to go to Colombia for a vacation after I defend. It was quite a disturbing read, both in terms of the drug violence and the shady US involvement in Latin American politics, but gave me a much better sense of the history of the drug trade in Colombia.

4. Random stuff: These kinds of distractions are impossible to avoid, and occur all to frequently in the world. The latest:

That’s right, the translation of “Peppermint to the max” is transliterated back into English as “An explosion of peppermint”! This seems less funny now that I’m actually writing it down, but I’ll leave it here as an indicator of how punchy things are getting at my place as the dissertation defense draws near.

Oh distraction...

Twilight Woods

A few weeks ago, Alicia called in sick and came over to spend some quality time with Nurse Walter. She snuggled under the blanket with him on the couch for a little rest and relaxation, and in doing so, she unwittingly created a new nickname for the dog. When I came home, I thought the dog was wearing cologne, or more specifically, some vaguely doggy version of Twilight Woods, a Bath and Bodyworks fragrance that Alicia likes. Since that time, I’ve been calling him variations on Twilight Woods, including, but not limited to, Wimptini Woods and Twilight Walt.

I now present you with the most recent of the gratuitous dog photos:

Nurse Wimptini Woods relaxes in his lotion scented blanket after his sick charge heads home.

Dante is our upstairs neighbor, and he and Walt have discovered tug of war. Dante does not know of Walt's most embarrassing series of nicknames yet.

As much as Walt enjoys tug of war, his favorite part is winning.

Walt attacks from below.

This is what I saw when I searched for the source of some quiet wimpering this evening. I think he vaguely needed to go out but couldn't quite bring himself to get out of the bed.

More (and better) bread

I posted a week or so ago about giving bread baking a try, and being quite happy with the results. More recently, however, I tried the original No-Knead Bread recipe adapted by Mark Bittman from the recipe Jim Lahey uses at the Sullivan Street Bakery. It is better. I would also note that if the bread is going to rise for 4 hours it might as well rise for 12-14 hours. I made the dough the night before and baked it last Friday morning.

I did not have a ceramic pot like the one called for in the recipe, and so created a bread terrarium out of Pyrex bowls. It worked!

The only issue seemed to be the apparent stickiness of the bowls, so next time I'll use a little oil to prevent the sticking.

I’ve been eating it all week, and it is amazing. The crust is crunchy and delicious, while the inside is spongy and nice. The only modification I made was to substitute 1 cup of multigrain flour with 2 cups of all purpose flour for the 3 cups of all purpose flour the recipe calls for.

As I type this I’m letting two more loaves rise in the kitchen, slightly upping the proportion of whole wheat or multigrain flour (one loaf of each) to 1.5 cups. Yum!

A rose by any other name

Shortly after I hit submit on the post yesterday, I was made aware of a new study suggesting that choices, not discrimination, were currently causing the sex differential in the life sciences. The study is quite good, reanalyzing and summarizing much of the data on sex discrimination in manuscript review, interviewing processes, and hiring in the life sciences. It is heartening to see that many recent interventions in blinding reviews and mentoring female candidates, along with societal progress among other things, have reduced the discrimination that women have historically faced. What I take issue with, however, is the distinction the authors make between “discrimination,” which they seem to define as bias in some aspect of the peer review or hiring process, and “choices,” which encompasses every other element of a career trajectory, including decisions made in elementary and high school about the acceptableness of a career in math or science. While the authors acknowledge that many of the “choices” they identify are constrained by biology and society, I think that if they looked more closely this would more accurately be described as structural discrimination or bias. Although individuals may not be consciously holding women to a higher standard than men, or discounting female accomplishments, the fact that women cannot have children and meet tenure requirements, while men are able to do this because of the different societal expectations around child-rearing, to me represents an institutionalized level of discrimination that goes far beyond the personal biases that the authors of this study dismiss as noncontributory. The decision to leave, or not to seek out, a tenure-track position because it “demands that women having children make their greatest intellectual contributions contemporaneously with their greatest physical and emotional achievements, a feat not expected of men,” is in fact a choice, but the discrimination lies in the fact that it is a choice “that men are not required to make.”

Awesome news…

From Dose of Reality:

The New York Times reported this morning on a new study of physician pay. The conclusion was that the pay gap between new (just finishing residency or fellowship) male physicians and new female physicians is actually larger now (adjusted for inflation) than it was in 1999. This is not good. It is also not explained in their analyses by differences in hours worked, specialty choice, practice setting, or other observed characteristics. The authors suggest that this widening gap may be explained in part by a disproportionate number of female physicians taking jobs with practices that offer “greater flexibility and family-friendly attributes…that come at the price of commensurately lower pay.”

I can’t decide how to react. On the one hand, I appreciate the increasing flexibility I’ve observed in medical practice, and understand that these benefits are likely to come with trade-offs. On the other hand, I’m frustrated at the idea that only women are interested in these benefits, or even that disproportionate numbers of women are interested in these benefits, and maybe even a little angry that it’s still okay to expect that a physician forgo all aspects of non-work life in order to be at the top of the profession. While I know it’s unreasonable, there’s a part of me that wants everyone to HAVE to have a life, so that I don’t feel behind if I choose to have one. What’s a girl to do?

Happy Birthday to me…

I haven’t thrown myself a birthday party in a while, but thought it would be a good way to see some friends. I also thought it would be a good way to enjoy some desserts. Once things got going I was having fun and forgot to document the vast array of sweets that filled my table, but you’ll have to trust me that they were awesome, and included oreo cheesecake, coconut cream pie, peanut butter cups, chocolate chip cookies, flourless chocolate cake, chocolate cookies, dark chocolate cupcakes, salt caramels, and marshmallows. I confess, however, that I was most excited by the marshmallows I made earlier in the day. This was not because they were the most delicious offering (by a long shot!), but because they were the most novel to me. I exhorted people to eat them all night, but am not-so-secretly pleased that there are leftovers today!

I was inspired to make the marshmallows by a post I read on Design*Sponge, and while I didn’t manage to put together the beautiful table arrangements that were the feature of the article, I immediately bookmarked the homemade marshmallow recipe. I followed it pretty exactly, stirring in a few spoonfuls of hot cocoa mix at the end, so I won’t duplicate it here, but I encourage you to give it a try.

In addition to the marshmallows, I made salt caramels (delicious!) and dark chocolate cupcakes, so I had a lot of materials (aka, butter) at the ready in the kitchen...

It turns out that marshmallows are really just hot (240F) sugar whisked with cool moist gelatin for a while.

Once they'd cooled completely, I started cutting them into little hearts because that was the only cookie cutter I had (and covered them with powdered sugar). I think I got rid of some Easter themed cutters a few years ago, and in retrospect should have kept them: the possibility of actually good-tasting peeps might motivate me to make this recipe again in the spring and cover them with colored sugar.

When I got tired of that, I cut up the rest into squares.

Finally, here are the cupcakes, the last photo taken before the fun began. (Actually, I'm pretty sure that between the taking of that photograph and the actual start of the party, I cleaned my entire apartment, made chocolate buttercream frosting, and frosted them, but who's counting...)

Bread

I think it was my wild success with the muffins that prompted me to consider baking bread. I’ve happily made biscuits and sweet breads before, but since a rather unfortunate doorstop of a loaf of something or other, I haven’t baked regular bread for sandwiches or toast, or any of the other usual things I use bread for. The other part of the motivation was this: I use bread for a lot of things. For example, I believe my toast consumption is higher than your average person, and I include it in my arsenal of not only delicious breakfast foods, but also snack, lunch, and dinner foods, with the right toppings.

Enter the vague recollection of a simplified bread recipe Mark Bittman posted a few years ago (and updated a few years later to include not only a faster recipe, but a whole wheat version). With my self-imposed snow day on Wednesday (because really, we only got a total of about 6 inches of snow all told), I realized that I could be home to monitor the progress of the bread. Now, the beauty of the originally posted recipe is that you let it sit for a long time by itself. I wanted to try to gain the supposed benefits of long rising times with only a slight increase in the amount of yeast so that I could cut the time from 14-20 hours to about 8, rather than to the 4 that Bittman adjusted to.

The result:

A smaller loaf than I had expected, but one that is still delicious. It’s not particularly dense (a concern I had considering the mix of whole wheat and multigrain flour I used), though it does not resemble the non-whole wheat photos at all, and it’s tasty. It is a little saltier than I would like, and I’ll cut the salt in the whole wheat recipe next time. The only adjustment I made was to use 1/2 tsp yeast, half the amount called for in the fast recipe (1 tsp), which worked out to twice the amount called for in the slow one (1/4 tsp), a symmetry I considered to be fate. I will be experimenting with rising times and flour mixes in the future to identify an ideal, but even at it’s unrefined starting point, it’s pretty delicious!

Have passport, will travel

My new passport arrived in the mail yesterday, and I’m pretty excited. Not only does it mean that my documents are all ready for an upcoming trip to Colombia, but it also means this:

What?!? Clearly passport technology has come a long way in the past 10 years. I am hopeful that this sensitive electronic technology will function like Jedi mind control and I will be allowed to board the plane last (and thus spend the least amount of time seated) but still find a space in the overhead bin for my bag…

Sundance USA

This was the second year that the Michigan Theater participated in Sundance USA. Last year, the featured film was Cyrus, and one of the writer/directors (The Duplass Brothers) as well as Jonah Hill (one of the stars of the film) flew to Ann Arbor and answered questions about the film after the showing. This year, the theater was honored to not only show an official film selection from Sundance 2011 (Win Win) and a selection of shorts from 2010 as a part of Sundance USA, but was able to add an additional film (Cedar Rapids) that was filmed in Ann Arbor and the surrounding areas.

The 2010 shorts were in general quite entertaining. Some were better than others, but I think the night was carried by two short films in particular: Wisdom Teeth is an animated short about pulling a stitch out after a wisdom tooth extraction that is a bit disturbing, but really great; Drunk History is a live action film about what happens when Jen Kirkman drinks two bottles of wine and then talks about Abe Lincoln. You can watch Drunk History at the link above, and many of the other shorts have made it online at this point, so check them out!

Both the films from this years festival were great. Last night we saw Win Win for Alicia’s birthday. Paul Giamatti was fantastic, and although I found it to be kind of sad, it was really quite funny throughout the film. I forgot to bring my camera last night, but grab my fancy new camera bag tonight before the show. We saw Cedar Rapids, which was also a bit of a comedy-with-a-moral. Filmed in Ann Arbor and set in Cedar Rapids, Iowa, it was a premise that was immediately familiar to me. I enjoyed seeing shots of the Broadway Bridge and the old power station (both on my walk to the farmers’ market).

Before the show started, the mayors of Ann Arbor and Cedar Rapids, IA took the stage, with Mayor Hieftje presenting the Iowan mayor with a key to the city.

Following the show, the director answered questions (and thanked all of the extras who had shown up for the screening)...

I’m hoping both of these films will gain broader distribution, but look for them in a town near you, and watch for a Sundance USA event near you next January!

Hello history taking…

From AMSA On Call:

Post #5 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

Last week I saw a real patient by myself for the first time. Granted, my actions had absolutely no bearing on his care as I was only seeing him as part of my program's official reentry clinical experiences, but nonetheless, I saw a patient by myself. It was profoundly different from every other experience I’d had conducting a history and physical examination. Unlike practicing with a friend or a standardized patient, this patient wasn’t directly evaluating my skills.  There would be no debriefing with him at the end of the afternoon to discuss whether or not he thought I had adequately checked for organomegaly on the abdominal exam (aka, enlarged liver or spleen), or how I might have more carefully guided him through a recounting of his past medical history. Unlike previous sessions where I was observed directly by an attending physician, there was no doctor present. There was no instructor correcting my percussion technique or reminding me to ask about medication allergies, or noting carefully that I should have been more diligent about screening for domestic violence. Unlike clinical examinations, and unlike many of my clinical experiences to come, there was no time limit. I had as much time as necessary to meander through a history and struggle through a physical exam. All of these differences did make the whole experience less stressful, but highlighted for me the value of having patients who are either truly performing (as my colleagues and standardized patients had done), or those who recognize that they are being watched by a doctor as part of a clinical exercise and put on their best helpful patient facade. Instead, I got a friendly and talkative gentleman (carefully selected for me by the charge nurse) who assumed I was a nurse and wound his way through a baffling series of events that proved to comprise his entire life history, occasionally touching on episodes related to his medical condition.

As a student training in public health, I firmly believe that the social determinants of health are as important as any explicitly medical issue. You’ll note that in the previous sentence, however, that I place those two things on equal grounding, indicating that a good history has to lead to a good understanding of what medical issues and interventions led the patient to the current state, as well as the social issues and interventions along the way. At this point, I can safely say that I am not a good history taker. I am excellent at establishing rapport with the patient, am careful not to interrupt too soon, aware that data suggest that responding too soon to the first things a patient says can lead the history taker astray (possibly missing more urgent problems further along in the patient’s story), and generally leave the interaction with a vast knowledge of the patient’s children, eating habits, and hospital preferences.  I am not yet excellent at knowing when to redirect a conversation in a more productive direction (say, to illuminate some aspect of the past medical history), or how to suggest that a topic of conversation may be inappropriate (for example, the patient’s perception that an outside hospital is inferior and begins listing examples). Striking the balance between empathic confidante and authoritative information-seeker is difficult, and I’m convinced that this is not made easier by small stature, female sex, and clinical inexperience, none of which is easily disguised on the wards. So what is the rusty and inexperienced clinician (dare I even call myself that at this point) to do? Fortunately, interactions with those further along in this process suggest that ultimately, clinical experience overcomes most additional barriers, and that it becomes easier to matter-of-factly state, “No, I am the medical student/doctor.” This, fortunately or unfortunately, depending on how you look at it, leaves me with only one option, and only one recommendation for you, dear readers, should you find yourselves in a similar position: practice. That’s right. As in all things, I can only hope that if I try and try again, eventually I’ll succeed.

A very big concert

Last Sunday was a very big concert for the Life Sciences Orchestra in just about every sense of the world. It was the 10th winter concert for the LSO, marking a decade of physicians, public health faculty, graduate and undergraduate students and many others making music together. It was remarkable (according to reputable sources) that an non-professional orchestra put together Mahler’s Second Symphony, which is a substantial piece of music to say the least. It was a big commitment for audience members to listen through 90 minutes of music without an intermission. And finally, it was a big group of musicians: over 100 singers and nearly 100 musicians according to the official press release. I still feel a little overwhelmed by the whole thing!

In case you missed this one, mark our next one on your calendar: Thursday, April 22, 7pm at Hill Auditorium. We’ll be playing:

Beethoven: Egmont Overture
Dvorák: Cello Concerto, I Mvt.
Berio: Ritirata notturna di Madrid
Falla: Three-cornered Hat (Suite No. 1)
Ravel: Rapsodie espagnole

The economics of muffins or, why I love Ash

To eat all the muffins at once, or not: a discussion of rational decision-making

By A. Knittel

Objective: To determine whether to save all the muffins for later, eat all the muffins now, or to define a mixed strategy, saving some of the muffins and eating some now.

Analysis: When a fresh batch of muffins is prepared, the rational individual is faced with a series of decisions about the fate of said muffins. Saving the muffins for a later time would ensure that the individual had a ready supply of snacks, but the muffins lose value because they become something to be enjoyed in the future (and so are discounted). Eating all of the muffins in one sitting, however, invokes the possibility of diminishing returns. After eating 9 muffins, eating the 10th does not bring the same level of joy that the first did.

Given this dilemma, the rational muffin eater is left with the following options: a series of differential equations estimating the maximum utility for a given number of muffins, or a game theoretic model where one player aims to eat all the muffins immediately, the other aims to save all the muffins, and the optimal strategy for each is a mixed one.

Conclusion: The maximum muffin utility clearly occurs when there is a balance between the amount of time, though both analytic approaches require calibration using observed preferences for muffin eating.

Acknowledgements: I would like to thank Ash for providing critical comments during the development of this manuscript. She deserves most of the credit, though any remaining errors are my own.

***
Many of you know that I listen to a lot of podcasts each week. I listen while I walk the dog (2 x 15-45 minutes x 7 days), I listen while I ride the bus (2 x 10-20 minutes/day x 5 days), I listen while I cook dinner (20-50 minutes x 3-5 days), and sometimes I listen while I knit or while I work out (30-90 minutes x 1-2 days). Having done the quick math, you’ll realize that I listen anywhere between 6.5 and 21 hours each week. One of my favorites is the Planet Money Podcast that started at the peak of the financial crisis, but which has expanded to cover a variety of topics from an economic point of view. In recent months I’ve also added the Freakonomics Podcast to my repertoire. Though I am by no means an economist (and become frustrated when they try to take over disciplines I care about), I do enjoy a bit of the economics every now and then. Enter Ash.

As many of you know, I enjoy Ash all the time. She is on my short list of the most awesome people ever for a variety of reasons, none the least of which is her ability to highlight the econometric potential of every situation. By way of explanation for the above, the following is a (slightly modified) conversation:

Me: Um... I just paid $2.50 for a muffin. I think I might bake some stuff tonight to bring into school.

Ashleigh: Seems wise.

Me: Can you freeze things like muffins easily?

Ashleigh: Yes. They aren't quite as good, but they do freeze well.

Me: I think the freezing would not only be the best option for storage at school, but would eliminate the "I feel a tiny bit hungry so I’ll eat 10 muffins from my desk" option.

Ashleigh: But muffins taste so good at desks.

Me: But i think the literature is clear that the 10th muffin is less good than the 1st (when they are eaten all at once).

Ashleigh: Yes, that's true.

Me: So if i freeze them and bring them in then I can eat 1 at a time at my desk.

Ashleigh: Maximum utility from the set number of muffins... depending on the discount rate.

Me: How would the discount rate apply to muffins?

Ashleigh: Well, if you enjoy immediate gratification like the rest of the humans... there will be a muffin discount rate. I'm pretty sure there will be a positive one in this case.

Me: I see. So the pain and suffering of waiting for the next muffin will diminish the enjoyment compared to just eating them all.

Ashleigh: Basically the principle of a bird in the hand is worth 2 in the bush.

Me: A muffin in the hand is worth 10 in the freezer? But what if you have 1 in your hand AND 10 in the freezer? Then it is a question of whether the future discounting is more than the diminishing return, right?

Ashleigh: Yes, you've got it.

From there we may or may not have spent a total of several hours trying to work through the differential equations (which got ugly quickly) and also some game theoretic models, each time reaching the conclusion that we needed more concrete information about the preferences.

Basic Muffins

adapted from How to Cook Everything, by Mark Bittman

3 tablespoons melted butter, canola oil, or other neutral oil
2 cups all-purpose flour
1/4 cup sugar
3 teaspoons baking powder
1 egg
1 cup of milk (I used a mixture of rice milk and water... I really need groceries...)
1/2 cup hazelnuts
1/2 cup raisins
1/2 cup frozen strawberries

Preheat the oven to 400F and grease a muffin tin. Chop the hazelnuts, raisins, and strawberries in the food processor. I did them separately, but you could probably just throw everything in there. Mix the dry ingredients and set them aside. Beat together the egg, milk, and butter/oil. Dig a space in the dry ingredients, and pour the wet ingredients into it. Using a spatula, combine the ingredients by stirring and folding rather than beating, and stop as soon as all the dry ingredients are moistened. The better should be lumpy and thick, but quite moist. Stir in the nuts, raisins, and berries.

Spoon the batter into the greased tin, filling them about 2/3 full (avoiding further mixing of the batter). Bake 20 to 30 minutes, until they are browned and a toothpick comes out clean. Serve warm (even if you freeze them; Ash recommends toasting after they are thawed).

MLK and gratuitous dog photo

Yesterday was one of my favorite holidays during the school year. I’ve been attending the Martin Luther King Jr. Symposia here at UM for a long time (in fact, this may have been my 10th!), and I really enjoy the chance to take a brief break and hear someone interesting talk about something important. This year’s symposium, with the theme “We the People… Realizing the Dream?” was kicked-off yesterday morning by Shirley Sherrod, the former USDA Director of Rural Development in Georgia who was fired after some remarks she’d made were wildly distorted in a right-leaning media frenzy. Her message encouraging each person to consider what she/he could to to promote social justice was a welcome one, and I enjoyed her talk, despite of the frequently strong religious tones that don’t resonate particularly well with me.

Even before the question and answer period ended after the keynote address, I headed over to the hospital for the Health Sciences MLK event featuring Sherman James speaking about the legacy of health disparities from the Civil Rights Movement. I wasn’t able to stay through the entire talk, however, before I headed up to the 7th floor of the hospital to… see a patient by myself! Fear not, nothing I did made any difference (for better or worse) in the patient’s care. I’ll post more about how that went later in the week.

To close, I’ll remind you all what sunshine looks like:

This was only taken over the weekend, but already seems so distant after a day of “ice pellets” falling from the sky.

A troubling start

I had high hopes for Michigan’s new governor, Rick Snyder. Although I lean more than a little to the left, I understood the push I saw in the last election cycle for fiscal responsibility in our state government. What I had hoped, however, was the Gov. Synder would focus his energies on fixing the economic woes of our state, and leave behind the extreme social conservatism that Michigan Republicans seem to love. His first few weeks in office would suggest that this is not the case. As reported in Between The Lines, Synder’s appointment to head up the Michigan Department of Human Services is Maura Corrigan, currently a MI Supreme Court Justice. For those of you who have been around for a while, you may recognize her name as the justice who ended second parent adoptions for same-sex parents in 2002. As Jay Kaplan of the ACLU points out in the BTL article, in spite of not having a case before her, Corrigan encouraged another judge to stop the adoptions that were only taking place in Washtenaw County, which he did by ordering the circuit clerical staff to not accept any more adoption petitions from unmarried couples. Many would consider this (*cue scary music*) judicial activism. This does not bode well. If the state government is looking to stop the brain drain that is devastating our economy, I think making Michigan a favorable legal climate for all families (married parents or not) is a great start.

Changing great expectations

From AMSA On Call:

Post #4 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

When I started medical school, there was substantial debate swirling about changing residency work hours, particularly for interns who were putting in untold hours at the hospital clearly to the detriment of their personal wellbeing, and potentially to the detriment of patient care.  These arguments sparked discussions of the best way to train physicians to work independently, how to maintain continuity of care without endless work hours, and even how to measure progress on these issues.  Ultimately, resident work hours were limited to 80 hours per week and shifts limited to 30 hours.  AMSA helped to draft the legislation that implemented these first changes, and continues to advocate for better conditions for residents and students. 

As I’m preparing to return to the wards, the controversy has flared again, though this time regulations have already passed.  The 80 hour work week remains in place, but first year residents (interns) may only work 16 consecutive hours.  (In addition, as detailed in news articles here and here, stricter rules for how residents should be supervised were added, and other regulations to improve patient care and resident safety were also included.)  On the whole, I’m happy to see medicine becoming a safer and more user-friendly profession, and hope that reduced physician burn-out will be a additional consequence of these regulations. 

In spite of these hopes, I nonetheless struggle with what a friend recently termed “competitive suffering.”  We’ve all experienced it before.  It’s what happens when you moan that you didn’t get enough sleep because you were writing a paper or studying for a test, and a colleague counters that he/she hasn’t slept in a week because of all of the work that needed to be finished.  Similarly, it occurs when one med student complains about an overnight shift on an OB/GYN rotation, and someone immediately pipes up that their transplant surgery rotation has required an unendingly flexible schedule and many sleepless nights.  Lately, I’ve noticed that it also happens when I express trepidation at the nights of call and night float I’ll be expected to work as a medical student, and my friends remind me that when they were in medical school, they were frequently in the hospital overnight, and that call expectations for medical students were much greater.  This often follows with exclamations of how much they learned at night because no one else was there, or of how amazing the patient was that they admitted in the morning and followed for a full 24 hours.  How is a returning student to deal with this, as medical student expectations are shifted with those of residents?  Certainly stepping back and saying “Wow, you had a rough go of it.  They sure do things differently now!” rarely feels like the right option, but most of the time, I think it is.  I try to remind myself that I learn more when I’m awake, and that my retention is laughable when I haven’t been able to sleep.  If that’s not enough, I think about the friends I’ve been lucky enough not to lose to drowsy driving accidents, or patients they’ve been lucky enough not to lose because of a sleepless error, and remind myself that these regulations mean that I’ll need to rely a little less on luck.

A year of knitting…

Always interested in tallying and keeping track of things, I was interested to see how much I had knit in the past year. As was totaled in the side bar before the new year, I’d knit just over 4 miles of yarn in 2010. According to Google, this is roughly 258,509 inches. If you figure that each stitch is a bit less than an inch, it is safe to say that I’ve knit over a quarter of a million stitches this year. But what exactly does that mean? It turns out that with a cool quarter mil, you can make the following items:

18 baby items (3 set of baby mittens, 6 baby hats, 1 baby sleep sack, 4 pairs of baby booties, 1 baby sweater, 1 baby sweater vest, 2 bibs)

1 dog sweater

8 shawls/scarves/cowls

1 hat

2 pair of mittens/gloves

2 pairs of socks

2 dishclothes

5 bangles

2 garments (1 sweater vest, 1 cardigan)

Not too shabby… Here’s to another year of crafting!

Welcome to Michigan, try not to freeze

From Dose of Reality:

Over the last few months I’ve met and spoken with many potential Michigan medical students.  They invariably have questions about how the coursework is structured in the medical school, whether I’m nervous about returning to the wards after many years in PhD-land, and what it’s like to live in Ann Arbor (as compared with a big city).  Only rarely do applicants ask about the winters…

My undergraduate thesis adviser once said something along the lines of “The people who settled Michigan were the ones who thought the fall was really pretty, and then ate the others during the winter.”  (I’m pretty sure my recollection of this quote has gotten more gruesome over the years, and that he likely said something more like “…and survived the winter” but I think my memory of the quote is closer to the sentiment of the original statement…  He did not like the winter.)  Though I didn’t used to dislike the winter much (except during the 1-2 weeks we have every year of –15F to –20F temperatures), I’ve become more frustrated with the weather as it gets weirder.  We’ve had less and less consistent weather during the time I’ve lived in Michigan (a veritable lifetime) and although I couldn't verify that it's getting colder, this year certainly seemed to. 

As I was reading the New York Times the other day, I found an opinion piece discussing how global warming is making the winters colder.  It involves a brief explanation of how snowfall in Siberia affects temperatures and snowfall in the Northeastern United States, and although the author loses points for citing himself, he makes some really great points.  I was particularly excited to see interesting conclusions being drawn from a computational model that suggested new hypotheses to be tested with data.  Unfortunately, given the current state of anything that might be described as decisive action on climate change, I am not optimistic.  This suggests to me that the weather here is just going to get stranger and stranger, and that we’ll have more weeks of sub-zero temperatures alternating with weeks of balmy 40-degree days.  Dear applicants, please join us at our amazing medical school, but hold on to your hats…  and coats…  and mittens…  and boots…  and light fall jackets just in case.

A year of ideas…

In preparation for the new year, a little reflection is (almost) always a good idea. In the case of the NYTimes Magazine, it definitely is. Their 10th Annual Year in Ideas is a great combination of inspiring, entertaining, and thought-provoking ideas. A few exciting ones include the youth condom, the long-life-span smartphone, and turbine-free wind power.

Read them all here!

A lovely visit

My apartment has mostly been converted into a pre-holiday sweatshop, but I have been enjoying myself nonetheless. At the very least, working hard on crafting all day provides a lovely change of focus. (And I will note that tomorrow I’m kind of hoping I have some time to work on my model results. This sort of anticipation and excitement about academic work has not been noted since the last break…) My eyesight-killing, shoulder-tightening labor, combined with the fact that many people are already out of town for the break, has meant that my social life is a bit limited. There is one visitor, however, for whom the crazy crafting is not substantial deterrent. In fact, I might even go to so far as to say she welcomes it. That visitor is… you guessed it… Ash!!!!!

She and Walter knit while I… also knit… and took pictures of them knitting… You see how this could potentially limit my social interactions…

Winter of Detroit, Part IV

Eastern Market and Supino Pizzeria

On Saturday, in spite of the cold, Alicia and I headed down to Eastern Market, the gigantic farmers’ market in Detroit. Calling it a farmers’ market doesn’t even really do it justice, as within the many stalls there are various artisans (soap-makers, chocolate-crafters, wreath-sellers) as well, and in the blocks surrounding the actual market, you can see the suppliers of seafood, meat, and equipment for all of the restaurants in the area. Also the suppliers of nuts:

We walked through all of the market, feeling sad for those vendors with the misfortune to be standing outside. Though the indoor sheds were by no means hot, they felt downright toasty compared to the cutting wind outside. I bought some apples and lemons, which were grown in Michigan and somewhere else respectively. Because the market supplies not only individual shoppers, but restaurants and other businesses, they have a much larger variety of produce than most farmers’s markets. Apparently restaurants need citrus even when the rest of us can only get cold storage apples…

After perusing the market for a bit, we followed Ruti’s (incredibly strong) recommendation that we hit Supino Pizzeria for lunch. It proved just as delicious as she’d promised! It’s a small place, so if you plan to go, you can call ahead and order so that you don’t have to wait. Tables are limited, but we only waited a few moments before someone finished and we were able to snag one. Another successful excursion in the winter of Detroit…

Happy Freezing Winter!

Walter wishes you all a warm and delightful life just like his:

Note: Walter has been unwilling to leave the house for more than a few moments since the temperature dipped below 20F. We should all learn something from this.

Finals: Work vs. Knitting

The title here really says it all…  Although I really only have one final exam this semester (and it is today!), I have other big end-of-semester deadlines (for example, a complete dissertation draft).  As always happens, I have also added to my list of holiday knitting at what is relatively at the last minute (considering that I started in May).  These two things have resulted in another battle in that time-honored struggle: work vs. knitting.  Luckily, thanks to a really awesome suggestion from a friend, I have been reading The Monday Motivator and am working on scheduling in my to-do list so that I make sure to do the things that are actually important to me (rather than the things that seem most urgent/doable at any given moment).  I’ve been creating the hourly schedules that used to indicate tragic finals stress levels, but now reflect that no one else is scheduling my time, so I might as well do it, and have met with some success.  My conclusions from the first week include:

• E-mail is a massive time suck and should be scheduled (and limited)
• Stata takes longer than you think, no matter how long you think it will take
• Thinking about what kind of crafting I want to do during a given week makes me feel productive and awesome, even if I do not follow the craft schedule (!)

All told, the scheduling is going well, and I am feeling that in the eternal fight between work and knitting, I, in fact, am winning.

Winter of Detroit, Part III

Detroit Urban Craft Fair and The People Mover

We headed down to the Fillmore Detroit last weekend to check out the Detroit Urban Craft Fair, and afterward I convinced Alicia that we should ride around the People Mover once, as it is only $0.50 to ride around the entire loop.

The Craft Fair was really quite good. They filled the lobby, the main floor, and the stage of the theater with booths for (mostly) local crafters and artists. I was impressed with the range of goods, though it was, I think, pretty typical of a good craft show: jewelry, textiles (dishcloths, knit and crochet items, pillows, potholders, etc), ceramics, and soaps, among other things. In addition, there were a few somewhat surprising booths filled with glass mosaics, little robot sculptures made from old flash bulbs and other electrical oddities, and dog collars. I must also note that there were some hand dyers there with yarn, and that I was good and did not purchase all of it… I found some great gifts, and would highly recommend your local craft show for stocking stuffers as well as bigger items that friends and family members don’t yet know that they need.

After we headed out into the bitter, bitter wind, I grabbed my camera and we headed up to the People Mover station. I think the last time I rode it all the way around was in elementary school when we got off at every station to learn about the art featured there. It's worth making the trip just to see the murals and other art pieces! Here is a pictorial tour of a round around the People Mover starting at Grand Circus Park Station.

Alicia with the uncannily realistic-looking statue at Grand Circus Park.

Looking down Woodward toward Comerica Park and the Fillmore Detroit.

Riding the people mover!

General Motors International Headquarters, The Renaissance Center

The river, looking particularly wintery and cold.

The bridge to Windsor.

Part of the mural at the Michigan Ave. Station.

Winter of Detroit, Part II

The Moth StorySLAM

I have been listening to The Moth Podcast for a while now. Each episode features stories from their various live events told, as their trailers for both the podcast and the radio show states, live without notes. Some of the stories are great, some are just okay, but when I heard on the podcast that they were now holding live events in Detroit, I made a mental note to check it out. I then promptly forgot.

Early last week, Alicia sent me a link and suggested that we check out the Moth StorySLAM held the first Thursday of every month at Cliff Bell’s, not far from Comerica Park, the Detroit Opera House, and the Fox Theater. We decided to leave Ann Arbor around 5:00pm in an attempt to get a table. The event was scheduled to start at 7:30pm, and the staff at the bar told Alicia that the tables fill up between 6:00-6:30pm (though there is standing room as well). Despite arriving shortly after 6:00pm, we did not get a table. We did, however, get the best standing seat in the house (in my opinion). Our view was slightly obstructed by a giant wooden column in the center of the room, but we were right near the servers’ station and not only did not have to move for every waiter (because we were positioned just out of their path), but were able to order beer and french fries from the waitress (who typed “LADIES” in the slot on the receipt where the table number is usually filled in).

A little blurry, but the BlackBerry wasn't really meant for indoor evening photos...

The stories were great. The theme was winter, and most of the stories stuck closely to it. My personal favorite was the last one, which featured girl concussed in a sledding accident that resulted in her saying all kinds of hilarious things to her date (who she had only just met). The winner was also quite good, with a no-fail combination of a little boy’s snow suit filled with pee and nuns (in a Catholic school).

Winter of Detroit continues…