Delicious Chicago

I went to lovely Chicago this weekend for the National Conference of Physician Scholars in the Social Sciences and Humanities. Actually, Chicago was not lovely for most of the weekend, as it rained and generally was cold and wet, but the places I went in Chicago were still delightful. My hotel was right on the river downtown, which is nice for conference going (as the conference was in the same area), but not all that nice for eating or much anything else (other than maybe picture-taking.

I headed directly to Wicker Park to take in the yarn fumes at Nina, my favorite Chicago knit shop. I found some lovely souvenir yarn, as well as a project bag that reminded me of this video:

Put a bird on it!

I was starving by this point, and knew that I wouldn’t make it to dinner without eating something soon. I stopped at the Milk and Honey Cafe, which served a surprisingly spicy corn soup, and was located next to yet another trendy bird sign, causing the hipster index of this neighborhood to spike off the charts.

After a brief stop at the Verizon store to get a new phone charger, I headed back to the hotel to drop off my purchases and headed back west to try out Green Zebra, a fancy-pants vegetarian restaurant I’d been meaning to try for a while now. It proved to mostly live up to the hype!

The salad was mediocre at best. The menu promised roasted squash, but there was none to be found. Toward the end it was even a little grainy, making me wonder whether the lettuce and scallions had been properly washed. The fig dressing was delicious though…

Dinner was amazing. I ordered the Farm Egg, which was a perfectly poached egg on top of smoked creamed potatoes, with little toasts forming a house around the egg. The potatoes were some of the best I've ever had.

Dessert was also incredible, making me wonder whether it is, in fact, only vegetables that cause problems at this vegetarian restaurant… The crème fraiche ice cream was 100% a reason to continue eating dairy…

The rest of the weekend was consumed with the conference, which was, as it was two years ago, a great source for thought-provoking talks as well as some of the best career information I’ve ever received. I think Adam, one of the conference organizers, put it best when he said “this is the conference of my people.” I thoroughly enjoyed getting to meet and reconnect with the other MD/PhD students in the social sciences and humanities!

Another knitter…

I spoke on a panel for a class of nursing students today. It was similar to all of the other panels I’ve done over the past 8 years or so, talking about gender, sexuality, and healthcare, except for one thing. Right after we came into the room, as the other panelists and I were organizing ourselves, the instructor walked onto the stage, introduced herself, and then proceeded to explain that she was going to knit during the panel and that we shouldn’t interpret that disrespectfully. I was so pleased to find another knitter! I told her about my own class/meeting/conference knitting, and revealed that I had a sock in my bag that I had considered working on during the panel, but had decided would be too distracting while I was presenting…

Back in the saddle again

Today was beautiful in Ann Arbor! True to form, it seems that the weather here has leapfrogged over spring into summer, and it was nearly 80F this afternoon. To celebrate, I went on a bike ride with Alicia. It was only 9.6 miles, but my legs are tired… I’m about to start composing an optimistic training schedule, even though I know that it’s likely that much of it won’t happen once rotations begin. I might as well at least have a plan, though…

One small step for a current student, one giant leap for me

From AMSA On Call:

Post #7 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

On Monday and Tuesday of this week, an incredibly gracious current M3 let me shadow him on the first two days of his inpatient pediatrics rotation. I would highly recommend this before returning from an extended absence, as it not only gives you a better sense of what will happen in the months to come, but gives the more advanced student a unique opportunity to demonstrate everything he/she has learned and to teach a newer student.

The logistics: The MD/PhD program identified a willing volunteer who was on an inpatient pediatrics rotation this month, which is what I’ll be doing in either May or June, and put me in touch with him. I decided not to go to orientation, as I knew I’d get my own orientation soon enough, but met up with him following orientation before rounds started for the day. I only spent a few hours with the team on Monday, but I got a good sense of how the team works in the hospital, and when I showed up for pre-rounding on Tuesday, I got a real sense of what medical students do with patients who’ve already been in the hospital for a while. I went on rounds again, saw the med students present, and helped with the tasks that followed.

The lessons: Do this! No amount of shadowing can prepare anyone completely for anything, but it can substantially decrease anxiety. I learned that even after eleven months of clinical rotations, there are still new things to learn and different approaches to adapt to on each service. I saw some great medical students in action, and learned that even folks who haven’t taken a break are constantly learning new things. I also learned that interns, residents, and even attendings are not scary (which should not have been surprising, as many of them were my med school classmates!), and are nice and helpful and willing to teach if you work hard, try new things, and aren’t afraid to ask questions. I also learned that “work hard” includes spending long hours at the hospital. I had a good sense before that this was the case, but spending just two half days in the hospital drove it home.

The bottom line: I need to start believing folks that this will all be fine! There will be long hours, and lots of work, but nothing insurmountable. I’m certain that as crazy as next month may be, at the end of it, I’ll join the chorus reassuring you that you too, will be fine.

Sometimes over-ambitious + under-prepared = good enough…

As some of you know, I’ve become a devotee of the Design*Sponge blog feature called Before & After. In this feature, wildly talented designers transform thrift store, basement, and dumpster finds into beautiful works of art. Some of them are quite pricey makeovers, but many simply use a yard or two of beautiful fabric to reupholster a chair, or a coat or two of paint or wood stain on a dresser. There is also a less frequent feature called Before & After Basics that demonstrates a wide range of techniques. Turning old (and often unattractive) pieces of furniture into beautiful things you’d want in your home appeals to me for so many reasons: it’s crafty, thrifty, and does not take 8 years to complete. Imagine my excitement when this lamp-and-side-table-combo showed up next to the dumpster in my apartment complex:

I initially grabbed the shade, thinking that it would work for a lamp I already had, and then when it became clear that it would not, I pulled the whole lamp inside. This is the point when I engaged in a healthy (?) dose of suspension of disbelief. In my head, a few short hours with some paint stripper, leftover bedroom wall paint, and some poly-acrylic finish would yield a table that was pale shiny finished wood with a delicate yellow border, with a matching base. Flash forward to the lamp and I in the bathtub, with me doing my darnedest to neither expose myself nor the municipal water system to the most eco-friendly paint stripper I could find. It became abundantly clear that I was not patient enough to get all of the paint off. Also, it seemed that the wood stain on the base of the lamp would have taken multiple applications of the stripper to remove. Tired and a little sore from hunching over and under the table, I cleaned everything up and let it all dry. Dreams of encountering a beautiful wood table dashed, I resigned myself to a yellow table with a yellow base. Three coats of paint later I was exhausted and it was time for bed. In the morning I applied two coats of water-based poly-acrylic finish, with only a little bit of dust and impatience leading to a less-than-perfect tabletop.

I set it next to my bed and am quite thrilled with the result, even if it’s not exactly what I dreamed.

Walter enjoyed snuggling in the blankets and pillows while I finished the lamp:

And then promptly posed for a photo when I tried to get a good picture:

Slow news day?

I find that on the slower news days, many of the things I’m actually interested in get covered. When there are no massive natural disasters, war is not declared (officially or unofficially), and celebrities are not making public their battles with substance use (officially or unofficially), questions about equity in terms of gender and sexuality are suddenly interesting fodder for discussion. It helps a bit that the Supreme Court has agreed to hear a case in which Wal-Mart claims that the women suing it for employment discrimination do not have enough in common to warrant a class-action suit. Although Wal-Mart would have you believe that the case has nothing to do with the sex discrimination the formed the basis of the case at the beginning, and that it is only about standing in the court, but I think it will be interesting (and maybe scary) to hear the discussion about whether or not having one’s sex and (former-)employer in common is enough to join up into a class-action suit. Below are a few other links I found interesting and though I’d share. Some of them are restricted (through the Chronicle of Higher Education), but even the little tidbits are interesting.

For Women Seeking to Advance in Academe, Advice From 4 Who Made It to the Top

Taking the Gender Fight Worldwide

Leadership Spots Opening Up for Gay and Lesbian Academics

Gay Academics Find New Paths to the Top

Episode 13: An ‘All-American’ Student Leader’s Search for Identity

Your Electronic Thesis and Dissertation (ETD) submission was successful.

From Dose of Reality:

This is what my e-mail said this morning after my post-defense meeting at the graduate school to review the formatting of my dissertation, turn in the final approval document, and submit my dissertation online to the library. When I asked about the publication fee I knew was owed to the University, however, I was informed that because I was an MSTP student this fee would not be assessed until I finished my MD, and that if I am lucky, it will have disappeared by the time I graduate. Hopeful as I am to avoid the $70 fee, I do wish, at least a little bit, that my dissertation could be available online (and in a bound version in my department) before 2013. Apparently they don’t process anything really until the degree is conferred, which in my case is not for another couple of years.

Lesson #1: No matter how much you love the MSTP, it is impossible to also love all of the exercises in delayed gratification.

Lesson #2: Publish your work so that you are allowed to show it to your family and friends before you graduate.

Relaxing

As has been discussed in this forum previously, I’m not good at relaxing. Really not good at relaxing. As a result, my schedule last week did not include work related to my dissertation (except for finishing up my revisions on Friday), but did include approximately 1,000,000 other things that needed to get done. I also started a running list of other stuff that needed to be completed before returning to the medical school. This sort of thing usually calms me because I feel more organized, but by yesterday afternoon I had worked myself into such a state that I was completely overwhelmed. I quickly realized that this was not good, and vowed (again) to relax a bit.

Success! This morning, Walt and I stayed in bed and read until after 9am and it was really wonderful. Walt did less reading, but still enjoyed the relaxing morning. I finished Little Bee, a book my Aunt Elizabeth sent for my birthday, and thoroughly enjoyed it. It was a surprisingly easy read for the subject matter (asylum-seeking, oil wars, and serious mental health issues, among others) and very well written. I enjoyed the style so much I purchased the audiobook version of the author’s other book, Incendiary. This is the kind of morning we had:

I also worked through my list of stuff to do and partitioned it out over the days of this week. I’m feeling good about getting everything done, and have reminded myself 2-3 times already that I have a few more weeks left as well.

In closing, here is a photo of Walter attempting to sleep on every item on the futon all at once:

There are actually two pillows underneath him...

Winter of Detroit Warms Up

Last week Alicia and I headed down to the D to transition our Winter of Detroit into Spring of Detroit. (As an aside, clearly the Michigan weather is confused about that transition, but my hopes are high that it will really be spring soon…) I know I’d heard about Small Plates before, but had never tried it out. Alicia snagged a great Groupon, and we were on our way to distract me from my impending defense. It was really quite delicious. For those of you unfamiliar with it, they feature a variety of appetizers and easily divisible entrees, and your table comes set with a stack of, yes, small plates. Everyone shares in the slightly-fancier-than-family-style family style. What we ordered:

• Caesar Salad (small)
• Veggie Spring Rolls
• Garlic Shrimp
• Chicken-Something Lettuce Wraps (I didn’t eat these…)
• French Fries

The salad was great, as were the spring rolls and the shrimp. I’d have to say that I could take or leave the fries, which was a bit disappointing. Overall, it was an enjoyable dinner!

I did not remember to bring my camera, but will leave you with a disturbing phone photo of the graffiti I saw on the way in. (Please accept my apology for posting a picture of graffiti in a post about Detroit - it's overdone and annoying, but this one relates to my academic work!)

Nothing has ever inspired me to think and talk about masculinity and the criminal justice system quite like this.

The Fit!

As many of you know, I bought a car yesterday. I found it late last week, and reserved it then, but I actually purchased it yesterday. As ambivalent as I was about owning my own vehicle (as I much prefer the bus, my bike, and walking), I realized over the past month that being carless in Ann Arbor was much more difficult than I’d thought. I suspect that I could probably survive without a car, but having transportation after 7pm and on Sundays without having to rely on someone else is really useful!

My first view from the car on Wednesday:

(I was still safely in the parking lot, so no need to worry…)

Now that it’s sunny today, I present to you, the Fit. I don’t believe in naming cars, so that’s all it is…

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!